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Moholdt T, Afoakwah C, Scuffham P, McDonald CF, Burrell LM, Stewart S. Excess mortality at Christmas due to cardiovascular disease in the HUNT study prospective population-based cohort in Norway. BMC Public Health 2021; 21:549. [PMID: 33743642 PMCID: PMC7980726 DOI: 10.1186/s12889-021-10503-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/12/2021] [Indexed: 01/08/2023] Open
Abstract
Background Although it is known that winter inclusive of the Christmas holiday period is associated with an increased risk of dying compared to other times of the year, very few studies have specifically examined this phenomenon within a population cohort subject to baseline profiling and prospective follow-up. In such a cohort, we sought to determine the specific characteristics of mortality occuring during the Christmas holidays. Methods Baseline profiling and outcome data were derived from a prospective population-based cohort with longitudinal follow-up in Central Norway - the Trøndelag Health (HUNT) Study. From 1984 to 1986, 88% of the target population comprising 39,273 men and 40,353 women aged 48 ± 18 and 50 ± 18 years, respectively, were profiled. We examined the long-term pattern of mortality to determine the number of excess (all-cause and cause-specific) deaths that occurred during winter overall and, more specifically, the Christmas holidays. Results During 33.5 (IQR 17.1–34.4) years follow-up, 19,879 (50.7%) men and 19,316 (49.3%) women died at age-adjusted rate of 5.3 and 4.6 deaths per 1000/annum, respectively. Overall, 1540 (95% CI 43–45 deaths/season) more all-cause deaths occurred in winter (December to February) versus summer (June to August), with 735 (95% CI 20–22 deaths per season) of these cardiovascular-related. December 25th–27th was the deadliest 3-day period of the year; being associated with 138 (95% CI 96–147) and 102 (95% CI 72–132) excess all-cause and cardiovascular-related deaths, respectively. Accordingly, compared to 1st–21st December (equivalent winter conditions), the incidence rate ratio of all-cause mortality increased to 1.22 (95% CI 1.16–1.27) and 1.17 (95% 1.11–1.22) in men and women, respectively, during the next 21 days (Christmas/New Year holidays). All observed differences were highly significant (P < 0.001). A less pronounced pattern of mortality due to respiratory illnesses (but not cancer) was also observed. Conclusion Beyond a broader pattern of seasonally-linked mortality characterised by excess winter deaths, the deadliest time of year in Central Norway coincides with the Christmas holidays. During this time, the pattern and frequency of cardiovascular-related mortality changes markedly; contrasting with a more stable pattern of cancer-related mortality. Pending confirmation in other populations and climates, further research to determine if these excess deaths are preventable is warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10503-7.
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Affiliation(s)
- Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,The Women's Clinic, St.Olav Hospital, Trondheim, Norway
| | - Clifford Afoakwah
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Paul Scuffham
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Institute for Breathing and Sleep, University of Melbourne, Melbourne, Australia
| | - Louise M Burrell
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia
| | - Simon Stewart
- Torrens University Australia, South Australia, Wakefield Campus, Adelaide, SA, 5000, Australia. .,University of Glasgow, Glasgow, Scotland, UK.
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Temporal patterns of suicide and circulatory system disease-related mortality are inversely correlated in several countries. BMC Psychiatry 2021; 21:153. [PMID: 33726707 PMCID: PMC7962271 DOI: 10.1186/s12888-021-03159-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/08/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Nearly 800,000 suicides occur worldwide annually and suicide rates are increasing faster than population growth. Unfortunately, the pathophysiology of suicide remains poorly understood, which has hindered suicide prevention efforts. However, mechanistic clues may be found by studying effects of seasonality on suicide and other mortality causes. Suicides tend to peak in spring-summer periods and nadir in fall-winter periods while circulatory system disease-related mortality tends to exhibit the opposite temporal trends. This study aimed to determine for the first time whether monthly temporal cross-correlations exist between suicide and circulatory system disease-related mortality at the population level. If so and if common biological factors moderate risks for both mortality types, such factors may be discoverable and utilized to improve suicide prevention. METHODS We conducted time series analyses of monthly mortality data from northern (England and Wales, South Korea, United States) and southern (Australia, Brazil) hemisphere countries during the period 2009-2018 (N = 41.8 million all-cause mortality cases). We used a Poisson regression variant of the standard cosinor model to determine peak months of mortality. We also estimated cross-correlations between monthly mortality counts from suicide and from circulatory system diseases. RESULTS Suicide and circulatory disease-related mortality temporal patterns were negatively correlated in Australia (- 0.32), Brazil (- 0.57), South Korea (- 0.32), and in the United States (- 0.66), but no temporal correlation was discernable in England and Wales. CONCLUSIONS The negative temporal cross-correlations between these mortality types we found in 4 of 5 countries studied suggest that seasonal factors broadly and inversely moderate risks for circulatory disease-related mortality and suicide, but not in all regions, indicating that the effect is not uniform. Since the seasonal factors of temperature and light exert opposite effects on suicide and circulatory disease-related mortality in several countries, we propose that physiologically-adaptive circulatory system responses to heat and light may increase risk for suicide and should be studied to determine whether they affect suicide risk. For example, heat and light increase production and release of the bioactive gas nitric oxide and reduce circulatory system disease by relaxing blood vessel tone, while elevated nitric oxide levels are associated with suicidal behavior, inverse effects that parallel the inverse temporal mortality patterns we detected.
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103
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Ogah OS, Umuerri EM, Adebiyi A, Orimolade OA, Sani MU, Ojji DB, Mbakwem AC, Stewart S, Sliwa K. SARS-CoV 2 Infection (Covid-19) and Cardiovascular Disease in Africa: Health Care and Socio-Economic Implications. Glob Heart 2021; 16:18. [PMID: 33833942 PMCID: PMC7977038 DOI: 10.5334/gh.829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 01/13/2021] [Indexed: 01/08/2023] Open
Abstract
The current pandemic of SARS-COV 2 infection (Covid-19) is challenging health systems and communities worldwide. At the individual level, the main biological system involved in Covid-19 is the respiratory system. Respiratory complications range from mild flu-like illness symptoms to a fatal respiratory distress syndrome or a severe and fulminant pneumonia. Critically, the presence of a pre-existing cardiovascular disease or its risk factors, such as hypertension or type II diabetes mellitus, increases the chance of having severe complications (including death) if infected by the virus. In addition, the infection can worsen an existing cardiovascular disease or precipitate new ones. This paper presents a contemporary review of cardiovascular complications of Covid-19. It also specifically examines the impact of the disease on those already vulnerable and on the poorly resourced health systems of Africa as well as the potential broader consequences on the socio-economic health of this region.
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Affiliation(s)
- Okechukwu S. Ogah
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Nigeria/Department of Medicine, University College Hospital Ibadan, NG
- Institute of Advanced Medical Research and Training, College of Medicine, University of Ibadan, NG
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, ZA
| | - Ejiroghene M. Umuerri
- Department of Medicine, Delta State University, Abraka, Delta State Nigeria/Department of Medicine, Delta State University Teaching Hospital, Oghara, Delta State, NG
| | - Adewole Adebiyi
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Nigeria/Department of Medicine, University College Hospital Ibadan, NG
| | - Olanike A. Orimolade
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Nigeria/Department of Medicine, University College Hospital Ibadan, NG
| | - Mahmoud U. Sani
- Department of Medicine Bayero University Kano & Aminu Kano University Teaching Hospital, Kano, NG
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, ZA
| | - Dike B. Ojji
- Department of Medicine, University of Abuja, Abuja, Nigeria/Department of Medicine, University of Abuja Teaching Hospital, Abuja, NG
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, ZA
| | - Amam C. Mbakwem
- Department of Medicine, University of Lagos, Akoka, Lagos, Nigeria/Department of Medicine, Lagos University Teaching Hospital, Idi-araba, Lagos, NG
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, ZA
| | - Simon Stewart
- Torrens University Australia, Adelaide, South Australia, AU
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, ZA
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, ZA
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104
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D'Ascenzi F, Cameli M, Forni S, Gemmi F, Szasz C, Fabrizio VD, Mechi MT, Nocci M, Mondillo S, Valente S. Reduction of Emergency Calls and Hospitalizations for Cardiac Causes: Effects of Covid-19 Pandemic and Lockdown in Tuscany Region. Front Cardiovasc Med 2021; 8:625569. [PMID: 33778021 PMCID: PMC7994258 DOI: 10.3389/fcvm.2021.625569] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/23/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction: Containment measures were established to flatten the curve of COVID-19 contagion in order to avoid a crash of the healthcare system. However, these measures influenced the rate of hospitalization of cardiac patients. In this study, we aimed to analyse the impact of COVID-19 and the effects of lockdown measures on hospital admissions and alerts of emergency medical system (EMS) for cardiac causes in the Tuscany region. Methods: An observational, retrospective analysis from Italian Tuscany region was conducted. We evaluated consecutive patients contacting EMS or admitted to the 39 Emergency Departments (EDs) in Tuscany for cardiac causes in the first trimester of 2020. Data were compared with the same period in 2018/19. Results: The alerts of EMS for cardiac causes significantly decrease in 2020 and the highest difference between 2018/19 and 2020 was found immediately after national lockdown (Δ = −47.4%, p < 0.001). The number of admissions for chest pain in the EDs also decreased, with a maximum difference of −67.6% (p < 0.001) vs. 2018/19. The number of hospital accesses for acute coronary syndromes, atrial fibrillation, and heart failure in the EDs significantly decreased in 2020 as compared to 2018/19 (maximum Δ = −58.9%, p < 0.001; maximum Δ = −63.0%, p < 0.001; maximum Δ = −72.7%, p < 0.001, respectively). Conclusions: A significant decrease in the contacts to EMS for cardiac causes and in cardiac diagnoses was observed during the first trimester of 2020. Fear of contagion has likely played a relevant role. The lesson learnt from first wave of COVID-19 pandemic suggests that appropriate public information strategies and re-education of people are essential.
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Affiliation(s)
- Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Silvia Forni
- Regional Health Agency of Tuscany, Florence, Italy
| | | | | | | | - Maria Teresa Mechi
- Quality of Care and Clinical Networks, Regional Health Department of Tuscany, Florence, Italy
| | - Matteo Nocci
- Quality of Care and Clinical Networks, Regional Health Department of Tuscany, Florence, Italy
| | - Sergio Mondillo
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Serafina Valente
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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105
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Kumar VRS, Choudhary SK, Radhakrishnan PK, Bharath RS, Chandrasekaran N, Sankar V, Sukumaran A, Oommen C. Lopsided Blood-Thinning Drug Increases the Risk of Internal Flow Choking Leading to Shock Wave Generation Causing Asymptomatic Cardiovascular Disease. GLOBAL CHALLENGES (HOBOKEN, NJ) 2021; 5:2000076. [PMID: 33728053 PMCID: PMC7933821 DOI: 10.1002/gch2.202000076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/13/2020] [Indexed: 05/04/2023]
Abstract
The discovery of Sanal flow choking in the cardiovascular-system calls for multidisciplinary and global action to develop innovative treatments and to develop new drugs to negate the risk of asymptomatic-cardiovascular-diseases. Herein, it is shown that when blood-pressure-ratio (BPR) reaches the lower-critical-hemorrhage-index (LCHI) internal-flow-choking and shock wave generation can occur in the cardiovascular-system, with sudden expansion/divergence/vasospasm or bifurcation regions, without prejudice to the percutaneous-coronary-intervention (PCI). Analytical findings reveal that the relatively high and the low blood-viscosity are cardiovascular-risk factors. In vitro studies have shown that nitrogen, oxygen, and carbon dioxide gases are dominant in fresh blood samples of humans/guinea pigs at a temperature range of 98.6-104 F. An in silico study demonstrated the Sanal flow choking phenomenon leading to shock-wave generation and pressure-overshoot in the cardiovascular-system. It has been established that disproportionate blood-thinning treatment increases the risk of the internal-flow-choking due to the enhanced boundary-layer-blockage-factor, resulting from an increase in flow-turbulence level in the cardiovascular-system, caused by an increase in Reynolds number as a consequence of low blood-viscosity. The cardiovascular-risk can be diminished by concurrently lessening the viscosity of biofluid/blood and flow-turbulence by raising the thermal-tolerance-level in terms of blood-heat-capacity-ratio (BHCR) and/or by decreasing the systolic-to-diastolic blood-pressure-ratio.
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Affiliation(s)
- Valsalayam Raghavapanicker Sanal Kumar
- Vikram Sarabhai Space Centre (SC CA No.6301/2013)Indian Space Research OrganisationThiruvananthapuramKerala695022India
- National Centre for Combustion Research and DevelopmentIndian Institute of ScienceBangaloreKarnataka560012India
- Department of Aeronautical EngineeringKumaraguru College of TechnologyCoimbatoreTamil Nadu641049India
| | - Shiv Kumar Choudhary
- Department of Cardiothoracic and Vascular SurgeryAll India Institute of Medical SciencesNew Delhi110029India
| | | | | | - Nichith Chandrasekaran
- National Centre for Combustion Research and DevelopmentIndian Institute of ScienceBangaloreKarnataka560012India
- Department of Aeronautical EngineeringKumaraguru College of TechnologyCoimbatoreTamil Nadu641049India
| | - Vigneshwaran Sankar
- Department of Aeronautical EngineeringKumaraguru College of TechnologyCoimbatoreTamil Nadu641049India
- Department of Aerospace EngineeringIndian Institute of TechnologyKanpurUttar Pradesh208016India
| | - Ajith Sukumaran
- Department of Aeronautical EngineeringKumaraguru College of TechnologyCoimbatoreTamil Nadu641049India
| | - Charlie Oommen
- National Centre for Combustion Research and DevelopmentIndian Institute of ScienceBangaloreKarnataka560012India
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106
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Gul M, Batur AF, Böcü K, Kaynar M, Kilic O, Göktaş S. Seasonal fluctuation of erectile dysfunction: A cross-sectional study from a tertiary university hospital across 10 years. Andrologia 2021; 53:e14019. [PMID: 33599339 DOI: 10.1111/and.14019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/29/2021] [Accepted: 02/07/2021] [Indexed: 12/11/2022] Open
Abstract
Erectile dysfunction (ED) shares several risk factors with diabetes mellitus (DM), hypertension (HT) and coronary vascular disease (CVD), which were well-associated with seasonal fluctuation with the highest peak in winter. In this study, we aimed to determine whether ED demonstrates seasonal fluctuations with the above-mentioned systemic diseases. Database from a tertiary university hospital between 2010 and 2020 was deciphered to retrieve patients diagnosed with ED. Patients with primary bladder tumour and post-procedural ED constituted the negative control groups from the same study period. International index of erectile function questionnaire (IIEF-15) was used to segregate included patients into mild/moderate and severe ED groups. The probability of detecting DM, HT and CVD in patients with severe ED was significantly higher than that of with mild/moderate ED (p < 0.05). More ED symptoms emerged and were diagnosed in the winter seasons even though no statistical significance was observed between patients with mild/moderate and severe ED (p = 0.946, Cramer's V coefficient = 0.19). The seasonal variation of patients with bladder tumour and post-procedural ED groups showed no significant difference (p > 0.05, both). ED admissions are associated with higher peaks in the winter seasons. This may help in daily clinical practice to warrant better clinical and epidemiological interpretation of ED.
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Affiliation(s)
- Murat Gul
- School of Medicine, Department of Urology, Selcuk University, Konya, Turkey
| | - Ali Furkan Batur
- School of Medicine, Department of Urology, Selcuk University, Konya, Turkey
| | - Kadir Böcü
- School of Medicine, Department of Urology, Selcuk University, Konya, Turkey
| | - Mehmet Kaynar
- School of Medicine, Department of Urology, Selcuk University, Konya, Turkey
| | - Ozcan Kilic
- School of Medicine, Department of Urology, Selcuk University, Konya, Turkey
| | - Serdar Göktaş
- School of Medicine, Department of Urology, Selcuk University, Konya, Turkey
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107
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Shimizu K, Takahashi M, Sato S, Saiki A, Nagayama D, Harada M, Miyazaki C, Takahara A, Shirai K. Rapid Rise of Cardio-Ankle Vascular Index May Be a Trigger of Cerebro-Cardiovascular Events: Proposal of Smooth Muscle Cell Contraction Theory for Plaque Rupture. Vasc Health Risk Manag 2021; 17:37-47. [PMID: 33603388 PMCID: PMC7886257 DOI: 10.2147/vhrm.s290841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/22/2021] [Indexed: 11/23/2022] Open
Abstract
Cardiovascular diseases have been recognized as the main cause of death all over the world. Recently, the established cardio-ankle vascular index (CAVI) has become known as an index of arterial stiffness of the arterial tree from the origin of the aorta to the ankle. CAVI reflects the progress of arteriosclerosis, and a rapid rise in CAVI indicates arterial smooth muscle cell contraction. Considering the vasculature of the atheroma where vasa vasorum penetrates the smooth muscle cell layer and supplies blood to the intimal atheromatous lesion, a rapid rise of CAVI means "choked" atheroma. Thus, we proposed a "smooth muscle cell contraction" hypothesis of plaque rupture.
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Affiliation(s)
- Kazuhiro Shimizu
- Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Mao Takahashi
- Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Shuji Sato
- Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Atsuhito Saiki
- Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Daiji Nagayama
- Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Masashi Harada
- Department of Neurosurgery, Toho University Omori Medical Center, Omori, Tokyo, Japan
| | - Chikao Miyazaki
- Department of Neurosurgery, Toho University Omori Medical Center, Omori, Tokyo, Japan
| | - Akira Takahara
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Chiba, Japan
| | - Kohji Shirai
- Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Chiba, Japan
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108
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Garijo BM, Katz JE, Greer A, Gonzalgo M, López AG, Deane L, Ramasamy R. Increase in searches for erectile dysfunction during winter: seasonal variation evidence from Google Trends in the United States. Int J Impot Res 2021; 34:172-176. [PMID: 33574574 PMCID: PMC8964410 DOI: 10.1038/s41443-020-00397-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/10/2020] [Accepted: 12/02/2020] [Indexed: 12/12/2022]
Abstract
AbstractSeveral diseases associated with erectile dysfunction (ED), such as type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD), are known to have seasonal variation, with increased incidence during winter months. However, no literature exists on whether this chronological-seasonal evolution is also present within ED symptomatology. We hypothesized ED would follow the seasonal pattern of its lifestyle-influenced comorbid conditions and exhibit increased incidence during winter months. In order to investigate the seasonal variation of ED in the United States between 2009 and 2019, Internet search query data were obtained using Google Trends. Normalized search volume was determined during the winter and summer seasons for ED, other diseases known to be significantly associated with ED (T2DM and CAD), kidney stones (positive control), and prostate cancer (negative control). There were significantly more internet search queries for ED during the winter than during the summer (p = 0.001). CAD and T2DM also had significantly increased search volume during winter months compared to summer months (p < 0.001 and p = 0.011, respectively). By contrast, searches for kidney stones were significantly increased in the summer than in the winter (p < 0.001). There was no significant seasonal variation in the relative search frequency for prostate cancer (p = 0.75). In conclusion, Google Trends internet search data across a ten-year period in the United States suggested a seasonal variation in ED, which implies an increase in ED during winter. This novel finding in ED epidemiology may help increase awareness of ED’s associated lifestyle risk factors, which may facilitate early medical evaluation and treatment for those at risk of both ED and cardiovascular disease.
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Fico G, de Toffol M, Anmella G, Sagué-Vilavella M, Dellink A, Verdolini N, Pacchiarotti I, Goikolea JM, Solmi M, Vieta E, Murru A. Clinical correlates of seasonality in bipolar disorder: A specifier that needs specification? Acta Psychiatr Scand 2021; 143:162-171. [PMID: 33140436 DOI: 10.1111/acps.13251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/09/2020] [Accepted: 10/28/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Seasonal pattern (SP) is a bipolar disorder (BD) specifier that indicates a tendency towards affective relapses during specific moments of the year. SP affects 15%-25% of BD patients. In the past, SP was applied only to depressive relapses while, in DSM-5, SP may be applied to both depressive and (hypo)manic episodes. We examined the association between different clinical correlates of BD and SP according to its current definition in a cohort of patients with BD type I (BDI) and II (BDII). METHODS Patients were recruited from a specialized unit and assessed according to the season of relapse and type of episode per season. SP and non-SP patients were compared looking into sociodemographic and clinical correlates. Significant variables at univariate comparisons were included in multivariate logistic regression with SP as the dependent variable. RESULTS 708 patients were enrolled (503 BDI, 205 BDII), and 117 (16.5%) fulfilled DSM-5 criteria for SP. The mean age was 45.3 years (SD = 14.18), and 389 were female (54.9%). The logistic regression model included a significant contribution of BDII (OR = 2.23, CI 1.4-3.55), family history of mood disorder (OR = 1.97, CI 1.29-3.01), undetermined predominant polarity (OR = 0.44, CI 0.28-0.70), and aggressive behavior (OR = 0.42, CI 0.23-0.75). CONCLUSION Our results outline a novel positive association of SP with undetermined predominant polarity, BDII, family history of mood disorder, and with fewer aggressiveness-related symptoms. Seasonality is associated with a biphasic pattern with similar dominance of (hypo)mania and depression and is more frequent in BDII as compared to BDI. Seasonal episodes may be easier to predict, but difficult to prevent.
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Affiliation(s)
- Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Marco de Toffol
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain.,Neurosciences Department, University of Padua, Padua, Italy
| | - Gerard Anmella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Maria Sagué-Vilavella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Annelies Dellink
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain.,Behavioural and Cognitive Neuroscience Programme, Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Jose Manuel Goikolea
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Marco Solmi
- Neurosciences Department, University of Padua, Padua, Italy
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Andrea Murru
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
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Lombardi G, Gambaro G, Pertica N, Naticchia A, Bargagli M, Ferraro PM. Seasonality of acute kidney injury in a tertiary hospital academic center: an observational cohort study. Environ Health 2021; 20:8. [PMID: 33451322 PMCID: PMC7811228 DOI: 10.1186/s12940-021-00691-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 01/02/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The aim of our study was to describe seasonal trends of acute kidney injury (AKI) and its relationship with weather conditions in a hospitalized population. METHODS We retrospectively collected demographic (age, sex), clinical (ICD-9-CM codes of diagnosis discharge) and laboratory data (creatinine values) from the inpatient population admitted to Fondazione Policlinico Universitario A. Gemelli IRCCS between January 2010 and December 2014 with inclusion of all patients ≥18 years with at least two values available for creatinine. The outcome of interest was AKI development, defined according to creatinine kinetics criteria. The exposures of interest were the months and seasons of the year; air temperature and humidity level were also evaluated. Log-binomial regression models adjusted for age, sex, eGFR, comorbidities, Charlson/Deyo index score, year of hospitalization were used to estimate risk ratios (RR) and 95% confidential intervals (CI). RESULTS A total of 64,610 patients met the inclusion criteria. AKI occurred in 2864 (4.4%) hospital admissions. After full adjustment, winter period was associated with increased risk of AKI (RR 1.16, 95% CI 1.05, 1.29, p=0.003). Lower air temperature and higher humidity level were associated with risk of AKI, however in multivariable-adjusted models only higher humidity level showed a significant and independent association. CONCLUSIONS AKI is one of the most common complications of hospitalized populations with a defined seasonal pattern and a significant increase in incidence during wintertime; weather conditions, particularly higher humidity level, are independent predictors of AKI and could partially justify the observed seasonal variations.
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Affiliation(s)
- Gianmarco Lombardi
- U.O.C. Nefrologia, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Giovanni Gambaro
- U.O.C. Nefrologia, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Nicoletta Pertica
- U.O.C. Nefrologia, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Alessandro Naticchia
- U.O.C. Nefrologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Bargagli
- U.O.C. Nefrologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Manuel Ferraro
- U.O.C. Nefrologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
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111
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Milani GP, Simonetti GD, Edefonti V, Lava SAG, Agostoni C, Curti M, Stettbacher A, Bianchetti MG, Muggli F. Seasonal variability of the vitamin D effect on physical fitness in adolescents. Sci Rep 2021; 11:182. [PMID: 33420273 PMCID: PMC7794427 DOI: 10.1038/s41598-020-80511-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/02/2020] [Indexed: 12/12/2022] Open
Abstract
Studies investigating the relationship between vitamin D and physical fitness in youth have provided inconsistent findings. Recent evidence indicates that the expression of receptors and vitamin D-modulated genes in young subjects has a seasonal profile. Therefore, we investigated the role of vitamin D on physical fitness across seasons in a total of 977 male adolescents. Anthropometrics, lifestyle, dietary habits, biochemical profiles and physical fitness were studied. Multiple linear regression models, including pairwise interaction terms involving total 25-OH-vitamin D, were fitted. The interacting effect of season and total 25-OH-vitamin D had a significant influence on physical fitness performance (spring and total 25-OH-vitamin D: ß 0.19, SE 0.07, p = 0.007; summer and total 25-OH-vitamin D: ß 0.10, SE 0.06, p = 0.11; autumn and total 25-OH-vitamin D: ß 0.18, SE 0.07, p = 0.01), whereas the main effect of total 25-OH-vitamin D alone was not significant (p = 0.30). Body fat percentage, recreational physical activity level, time spent per day gaming/TV-watching, smoking, and hemoglobin levels were also related to the physical fitness performance score. Future studies should further explore the role of seasonal-dependent effects of vitamin D on health.
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Affiliation(s)
- Gregorio P Milani
- Istituto Pediatrico della Svizzera Italiana, 6500, Bellinzona, Switzerland. .,Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 9, 20122, Milan, Italy. .,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122, Milan, Italy.
| | - Giacomo D Simonetti
- Istituto Pediatrico della Svizzera Italiana, 6500, Bellinzona, Switzerland.,Università della Svizzera Italiana, 6600, Lugano, Switzerland
| | - Valeria Edefonti
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122, Milan, Italy
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, 1011, Lausanne, Switzerland
| | - Carlo Agostoni
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 9, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122, Milan, Italy
| | | | | | | | - Franco Muggli
- Swiss Federal Department of Defence, 3010, Bern, Switzerland
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112
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Zhang W, Du G, Xiong L, Liu T, Zheng Z, Yuan Q, Yang J, Wu Y, Zhu R, Hu G. Extreme temperatures and cardiovascular mortality: assessing effect modification by subgroups in Ganzhou, China. Glob Health Action 2021; 14:1965305. [PMID: 34482804 PMCID: PMC8425637 DOI: 10.1080/16549716.2021.1965305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Many people die from cardiovascular diseases each year, and extreme temperatures are regarded as a risk factor for cardiovascular deaths. However, the relationship between temperature and cardiovascular deaths varies in different regions because of population density, demographic inequality, and economic situation, and the evidence in Ganzhou, China is limited and inconclusive. Objective This study aimed to assess extreme temperature-related cardiovascular mortality and identify the potential vulnerable people. Methods After controlling other meteorological measures, air pollution, seasonality, relative humidity, day of the week, and public holidays, we examined temperature-related cardiovascular mortality along 21 lag days by Poisson in Ganzhou, China. Results A J-shaped relationship was observed between mean temperature and cardiovascular mortality. Extremely low temperatures substantially increased the relative risks (RR) of cardiovascular mortality. The effect of cold temperature was delayed by 2–6 days and persisted for 4–10 days. However, the risk of cardiovascular mortality related to extremely high temperatures was not significant (p > 0.05). Subgroup analysis indicated that extremely low temperatures had a stronger association with cardiovascular mortality in people with cerebrovascular diseases (RR: 1.282, 95% confidence interval [CI]: 1.020–1.611), males (RR: 1.492, 95% CI: 1.175–1.896), married people (RR: 1.590, 95% CI: 1.224–2.064), and people above the age of 65 years (RR: 1.641, 95% CI: 1.106–2.434) than in people with ischemic heart disease, females, unmarried people, and the elderly (≥65 years old), respectively. Conclusions The type of cardiovascular disease, sex, age, and marital status modified the effects of extremely low temperatures on the risk of cardiovascular mortality. These findings may help local governments to establish warning systems and precautionary measures to reduce temperature-related cardiovascular mortality.
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Affiliation(s)
- Wei Zhang
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, Gannan Medical University, Ganzhou, China.,Department of Occupational Health and Occupational Medicine, School of Public Health and Health Management, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Gang Du
- Ganzhou Center For Disease Control And Prevention, Ganzhou, Jiangxi, China
| | - Liang Xiong
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, Gannan Medical University, Ganzhou, China.,Department of Occupational Health and Occupational Medicine, School of Public Health and Health Management, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Tingting Liu
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, Gannan Medical University, Ganzhou, China.,Department of Occupational Health and Occupational Medicine, School of Public Health and Health Management, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Zuobing Zheng
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, Gannan Medical University, Ganzhou, China.,Department of Occupational Health and Occupational Medicine, School of Public Health and Health Management, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Qiong Yuan
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, Gannan Medical University, Ganzhou, China.,Department of Occupational Health and Occupational Medicine, School of Public Health and Health Management, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Jiahui Yang
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, Gannan Medical University, Ganzhou, China.,Department of Occupational Health and Occupational Medicine, School of Public Health and Health Management, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Yangna Wu
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, Gannan Medical University, Ganzhou, China.,Department of Occupational Health and Occupational Medicine, School of Public Health and Health Management, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Rongfei Zhu
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, Gannan Medical University, Ganzhou, China.,Department of Occupational Health and Occupational Medicine, School of Public Health and Health Management, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Gonghua Hu
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, Gannan Medical University, Ganzhou, China.,Department of Occupational Health and Occupational Medicine, School of Public Health and Health Management, Gannan Medical University, Ganzhou, Jiangxi, China
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113
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Lee M, Carter E, Yan L, Chan Q, Elliott P, Ezzati M, Kelly F, Schauer JJ, Wu Y, Yang X, Zhao L, Baumgartner J. Determinants of personal exposure to PM 2.5 and black carbon in Chinese adults: A repeated-measures study in villages using solid fuel energy. ENVIRONMENT INTERNATIONAL 2021; 146:106297. [PMID: 33395942 PMCID: PMC7762838 DOI: 10.1016/j.envint.2020.106297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/23/2020] [Accepted: 11/22/2020] [Indexed: 05/03/2023]
Abstract
Exposure to air pollution is a leading health risk factor. The variance components and contributions of indoor versus outdoor source determinants of personal exposure to air pollution are poorly understood, especially in settings of household solid fuel use. We conducted a panel study with up to 4 days of repeated measures of integrated gravimetric personal exposure to PM2.5 and black carbon in 787 men and women (ages 40-79) living in peri-urban villages in northern (Beijing and Shanxi) and southern (Guangxi) China. We simultaneously measured outdoor PM2.5 and collected questionnaire data on sociodemographic characteristics and indoor pollution sources including tobacco smoking and solid fuel stove use. We obtained over 2000 days of personal exposure monitoring which showed higher exposures in the heating season (geometric mean (GM): 108 versus 65 μg/m3 in the non-heating season for PM2.5) and among northern participants (GM: 90 versus 59 μg/m3 in southern China in the non-heating season for PM2.5). We used mixed-effects models to estimate within- and between-participant variance components and to assess the determinants of exposures. Within-participant variance in exposure dominated the total variability (68-95%). Outdoor PM2.5 was the dominant variable for explaining within-participant variance in exposure to PM2.5 (16%). Household fuel use (PM2.5: 8%; black carbon: 10%) and smoking status (PM2.5: 27%; black carbon: 5%) explained the most between-participant variance. Indoor sources (solid fuel stoves, tobacco smoking) were associated with 13-30% higher exposures to air pollution and each 10 μg/m3 increase in outdoor PM2.5 was associated with 6-8% higher exposure. Our findings indicate that repeated measurements of daily exposure are likely needed to capture longer-term exposures in settings of household solid fuel use, even within a single season, and that reducing air pollution from both outdoor and indoor sources is likely needed to achieve measurable reductions in exposures to air pollution.
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Affiliation(s)
- Martha Lee
- Department of Epidemology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Ellison Carter
- Institute on the Environment, University of Minnesota, Saint Paul, MN, USA; Department of Civil and Environmental Engineering, Colorado State University, Fort Collins, CO, USA
| | - Li Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Department of Analytical, Environmental & Forensic Sciences, School of Population Health and Environmental Sciences, Kings College London, London, UK
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; NIHR Imperial College London Biomedical Research Centre, London, UK
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Frank Kelly
- Department of Analytical, Environmental & Forensic Sciences, School of Population Health and Environmental Sciences, Kings College London, London, UK
| | - James J Schauer
- Department of Civil and Environmental Engineering, University of Wisconsin, Madison, USA; Environmental Chemistry & Technology Program, University of Wisconsin, Madison, USA
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Beijing, China
| | - Xudong Yang
- Department of Building Science, School of Architecture, Tsinghua University, Beijing, China
| | - Liancheng Zhao
- National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Jill Baumgartner
- Department of Epidemology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Institute for Health and Social Policy, McGill University, Montreal, Canada.
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114
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Kang J, Jeong YJ, Jang JH, Lee M. Risk Factors for Frailty in Critical Care Survivors: A secondary analysis. Intensive Crit Care Nurs 2020; 64:102981. [PMID: 33358896 DOI: 10.1016/j.iccn.2020.102981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 10/26/2020] [Accepted: 11/15/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the prevalence of frailty and its risk factors among critical care survivors who were discharged after receiving treatment in an intensive care unit. METHODS This was a secondary analysis using data from a methodological study conducted between June and August 2018. The sample included 494 adults who had been admitted to the intensive care unit for more than 48 hours within a year. Only post-intensive care frailty was evaluated using the Kihon Checklist. The sociodemographic and intensive care-related risk factors for frailty were analysed using multivariate logistic regression. RESULTS The prevalence of frailty in the sample was 65.8%. The risk factors for frailty were female sex (adjusted odds ratio [aOR] = 1.68, 95% CI: 1.02-2.78), aged 70 years or older (aOR = 4.16, 95% CI: 2.00-8.65), unemployment (aOR = 2.41, 95% CI: 1.39-4.17) and longer ICU days (aOR = 2.29, 95% CI: 1.35-3.91). Analysis of differences in risk factors according to sex revealed that risk factors for frailty were unemployment and longer ICU length of stay for male and older age for female. CONCLUSION Health care providers should be aware of frailty risk factors in female and male patients and provide patient-specific interventions for preventing frailty.
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Affiliation(s)
- Jiyeon Kang
- College of Nursing, Dong-A University, Busan, South Korea
| | - Yeon Jin Jeong
- Department of Nursing, Dongju College, Busan, South Korea
| | - Jun Hee Jang
- Department of Nursing, Dongju College, Busan, South Korea
| | - Minju Lee
- Department of Nursing, Youngsan University, Yangsan, South Korea.
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115
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Ikäheimo TM, Jokelainen J, Näyhä S, Laatikainen T, Jousilahti P, Laukkanen J, Jaakkola JJK. Cold weather-related cardiorespiratory symptoms predict higher morbidity and mortality. ENVIRONMENTAL RESEARCH 2020; 191:110108. [PMID: 32841633 DOI: 10.1016/j.envres.2020.110108] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/13/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Symptoms perceived in cold weather reflect physiological responses to body cooling and may worsen the course of a pre-existing disease or precipitate disease events in ostensibly healthy individuals. However, the associations between cold-related symptoms and their health effects have remained unknown. We examined whether cold-related cardiac and respiratory symptoms perceived in cold weather predict future morbidity and mortality. METHODS Cold-related symptoms were inquired in four national FINRISK surveys conducted in 1997, 2002, 2007, 2012 in Finland including altogether 17 040 respondents. A record linkage was made to national hospital discharge and cause-of-death registers. The participants were followed up until the first hospital admission due to a cardiovascular or respiratory disease or death, or until the end of 2015. The individual follow-up times ranged from 0 to 18 years (mean 11 years). The association of cold-related symptoms with morbidity and mortality was examined by Kaplan-Meyer and Cox-regression analyses. RESULTS Cold-related cardiac [hazard ratio (HR), 1.76 and its 95% confidence interval (95% CI), 1.44-2.15] and combined cardiac and respiratory symptoms [1.50 (1.29-1.73)] were associated with hospitalization due to cardiovascular causes. The respective HRs for admissions due to respiratory causes were elevated for cold-related respiratory [1.22 (1.07-1.40)], cardiac [1.24 (0.88-1.75)] and cardiorespiratory [1.82 (1.50-2.22)] symptoms. Cold-related cardiorespiratory symptoms were associated with deaths from all natural [1.38 (1.11-1.72)], cardiovascular [1.77 (1.28-2.44)] and respiratory [2.19 (0.95-5.06)] causes. INTERPRETATION Cold weather-related symptoms predict a higher occurrence of hospital admissions and mortality. The information may prove useful in planning measures to reduce cold-related adverse health effects.
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Affiliation(s)
- Tiina M Ikäheimo
- Center for Environmental and Respiratory Health Research, University of Oulu, FI-90014, Oulu, Finland; Medical Research Center, University of Oulu, University Hospital of Oulu, Oulu, Finland.
| | - Jari Jokelainen
- Medical Faculty, P.O. Box 5000, University of Oulu, FI-90014, Oulu, Finland; Unit of General Practice, Oulu University Hospital, FI-90029, Oulu, Finland
| | - Simo Näyhä
- Center for Environmental and Respiratory Health Research, University of Oulu, FI-90014, Oulu, Finland
| | - Tiina Laatikainen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), FI-00271, Helsinki, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, FI-70211, Kuopio, Finland; Joint Municipal Authority for North Karelia Social and Health Services (Siun Sote), FI-80210, Joensuu, Finland
| | - Pekka Jousilahti
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), FI-00271, Helsinki, Finland
| | - Jari Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, FI-70211, Kuopio, Finland; Central Finland Health Care District, Department of Medicine, Jyväskylä, Finland
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research, University of Oulu, FI-90014, Oulu, Finland; Medical Research Center, University of Oulu, University Hospital of Oulu, Oulu, Finland
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116
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Thermal Personalities of Older People in South Australia: A Personas-Based Approach to Develop Thermal Comfort Guidelines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228402. [PMID: 33202798 PMCID: PMC7698095 DOI: 10.3390/ijerph17228402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022]
Abstract
An important consideration for future age-friendly cities is that older people are able to live in housing appropriate for their needs. While thermal comfort in the home is vital for the health and well-being of older people, there are currently few guidelines about how to achieve this. This study is part of a research project that aims to improve the thermal environment of housing for older Australians by investigating the thermal comfort of older people living independently in South Australia and developing thermal comfort guidelines for people ageing-in-place. This paper describes the approach fundamental for developing the guidelines, using data from the study participants' and the concept of personas to develop a number of discrete "thermal personalities". Hierarchical Cluster Analysis (HCA) was implemented to analyse the features of research participants, resulting in six distinct clusters. Quantitative and qualitative data from earlier stages of the project were then used to develop the thermal personalities of each cluster. The thermal personalities represent different approaches to achieving thermal comfort, taking into account a wide range of factors including personal characteristics, ideas, beliefs and knowledge, house type, and location. Basing the guidelines on thermal personalities highlights the heterogeneity of older people and the context-dependent nature of thermal comfort in the home and will make the guidelines more user-friendly and useful.
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117
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Health effects of heat vulnerability in Rio de Janeiro: a validation model for policy applications. SN APPLIED SCIENCES 2020. [DOI: 10.1007/s42452-020-03750-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AbstractExtreme heat events can lead to increased risk of heat-related deaths. Furthermore, urban areas are often hotter than their rural surroundings, exacerbating heat waves. Unfortunately, validation is difficult; to our knowledge, most validations, even if they control for temperatures, really only validate a social vulnerability index instead of a heat vulnerability index. Here we investigate how to construct and validate a heat vulnerability index given uncertainty ranges in data for the city of Rio de Janeiro. First, we compare excess deaths of certain types of circulatory diseases during heat waves. Second, we use demographic and environmental data and factor analysis to construct a set of unobserved factors and respective weightings related to heat vulnerability, including a Monte Carlo analysis to represent the uncertainty ranges assigned to the input data. Finally, we use distance to hospital and clinics and their health record data as an instrumental variable to validate our factors. We find that we can validate the Rio de Janeiro heat vulnerability index against excess deaths during heat waves; specifically, we use three types of regressions coupled with difference in difference calculations to show this is indeed a heat vulnerability index as opposed to a social vulnerability index. The factor analysis identifies two factors that contribute to >70% of the variability in the data; one socio-economic factor and one urban form factor. This suggests it is necessary to add a step to existing methods for validation of heat vulnerability indices, that of the difference-in-difference calculation.
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118
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Cheng W, Ma XD, Su LX, He HW, Wang L, Tang B, Du W, Zhou YK, Wang H, Cui N, Long Y, Liu DW, Guo YH, Wang Y, Shan GL, Zhou X, Zhang SY, Zhao YP. Cross-sectional study for the clinical application of extracorporeal membrane oxygenation in Mainland China, 2018. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:554. [PMID: 32917257 PMCID: PMC7484920 DOI: 10.1186/s13054-020-03270-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/02/2020] [Indexed: 01/19/2023]
Abstract
Background To investigate the epidemiology and in-hospital mortality of veno-venous (VV) and veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) in Mainland China throughout 2018. Methods Patients supported by ECMO from 1700 tertiary hospitals in 31 provinces from January 1 to December 31, 2018, were selected from the National Clinical Improvement System database. Results The 1700 included hospitals had 2073 cases of ECMO in 2018, including 714 VV and 1359 VA ECMOs. The average patient age was 50 years (IQR 31–63), and 1346 were male. The average hospital stay was 17 days (IQR 7–30), and the average costs per case was $36,334 (IQR 22,547–56,714). The three provinces with the highest number of ECMO cases were Guangdong, Beijing, and Zhejiang; the southeast coastal areas and regions with higher GDP levels had more cases. Overall in-hospital mortality was 29.6%. Mortality was higher among patients who were male, over 70 years old, living in underdeveloped areas, and who were treated during the summer. Mortality in provinces with more ECMO cases was relatively low. The co-existence of congenital malformations, blood system abnormalities, or nervous system abnormalities increased in-hospital mortality. Conclusions Mortality and medical expenses of ECMO among patients in China were relatively low, but large regional and seasonal differences were present. Risk factors for higher in-hospital mortality were older age, male sex, in underdeveloped areas, and treatment during the summer. Additionally, congenital malformations and blood system and nervous system abnormalities were associated with in-hospital mortality.
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Affiliation(s)
- Wei Cheng
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Xu-Dong Ma
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China
| | - Long-Xiang Su
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Huai-Wu He
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Lu Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Bo Tang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Wei Du
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Yuan-Kai Zhou
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Hao Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Na Cui
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Yun Long
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Da-Wei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Yan-Hong Guo
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China
| | - Ye Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences (CAMS) & School of Basic Medicine, Peking Union Medical College, Beijing, 100730, China
| | - Guang-Liang Shan
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences (CAMS) & School of Basic Medicine, Peking Union Medical College, Beijing, 100730, China
| | - Xiang Zhou
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China.
| | - Shu-Yang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Yu-Pei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
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Altin SE, Kim YG, Aronow HD, Armstrong EJ, Goldsweig AM, Dardik A, Lanksy AJ, Mena-Hurtado CI, Abbott JD. Seasonal variation in U.S. hospitalizations for chronic limb-threatening ischemia. Catheter Cardiovasc Interv 2020; 96:1473-1480. [PMID: 32902126 DOI: 10.1002/ccd.29261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/22/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Seasonal variation in coronary artery disease is well described, with a peak in the winter and a trough in the summer. However, little is known about seasonal trends in hospital admission for critical limb-threatening ischemia (CLTI) and associated outcomes. METHODS Patients admitted with CLTI from January 1, 2012 through August 31, 2015 were identified in the Healthcare Cost and Utilization Project's National Inpatient Sample based upon administrative claims diagnosis codes. The primary outcome was seasonal hospitalization incidence, and secondary outcomes included mortality rates and rates of in-hospital major and minor amputations among nondiabetics and diabetics. RESULTS Of 1,276,745 hospitalizations for CLTI during the study period, 28.3% occurred in the spring, the peak admission season, and 19.1% occurred in the fall, the nadir. In-hospital mortality was highest during the winter (adjusted odds ratio [OR]: 1.08; 95% confidence interval [CI]: 1.03-1.14), and followed the highest seasonal rates of influenza in the fall; however, other important comorbidities did not differ significantly by season. For the overall cohort, there was no significant seasonal variation in rates of major or minor amputation, although seasonal rates were different according to diabetic status. Patients without diabetes had the highest odds of amputation in the spring (OR 1.07; 95% CI: 1.02-1.12), although this trend was not identified among patients with diabetes. CONCLUSIONS There is significant seasonal variability in CLTI admissions and mortality but minimal variability in amputation rates. Understanding the seasonal variation in CLTI may help to identify individuals at greatest risk for hospitalization and death through patient and provider education efforts.
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Affiliation(s)
- S Elissa Altin
- Division of Cardiology, Yale University, New Haven, Connecticut.,West Haven VA Medical Center, West Haven, Connecticut
| | - Yeunjung G Kim
- Division of Cardiology, Yale University, New Haven, Connecticut
| | - Herbert D Aronow
- Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Ehrin J Armstrong
- Division of Cardiology, Denver VA Medical Center and University of Colorado, Denver, Colorado
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Alan Dardik
- Division of Cardiology, Yale University, New Haven, Connecticut.,West Haven VA Medical Center, West Haven, Connecticut
| | - Alexandra J Lanksy
- Division of Cardiology, Yale University, New Haven, Connecticut.,Barts Heart Centre, University College London and Queen Mary University of London, London, UK
| | | | - J Dawn Abbott
- Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Shih CY, Chu ML, Hsieh TC, Chen HL, Lee CW. Acute Myocardial Infarction among Young Adult Men in a Region with Warm Climate: Clinical Characteristics and Seasonal Distribution. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176140. [PMID: 32847005 PMCID: PMC7503405 DOI: 10.3390/ijerph17176140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 11/16/2022]
Abstract
The aim of this cross sectional study was to investigate the influence of the seasons on acute myocardial infarction (AMI) among young adult among young adults aged <45 years compared to old adults aged ≥45 years. The seasonal distribution of AMI hospital admissions among young adult men in eastern Taiwan was assessed. Data were extracted from 1413 male AMI patients from January 1994 to December 2015, including onset date, the average temperature (Tave) on the date of AMI hospitalization (AMI-Tave), and conventional risk factors, notably smoking, diabetes, hypertension, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and body mass index (BMI). The 1413 cases were divided into two groups: the young group (n = 138, <45 y/o) and the older group (n = 1275, ≥45 y/o). The differences between groups were examined. Logistic regression analyses were used to evaluate the associations between the seasons and the AMI hospitalization among the young group. The young group showed significantly higher percentage of smokers, BMI, total cholesterol levels, and triglycerides levels but lower percentage of diabetes and hypertension than the older group (p < 0.05). AMI hospitalization in winter was significantly greater compared to the other seasons among the young group (p < 0.05). Winter hospitalization was significantly associated with the young group relative to the older group (adjusted OR 1.750; 95% CI 1.151 to 2.259), while winter AMI-Tave in the young group was similar to that in the older group. Young adult men diagnosed with AMI are more likely than older adult men to be smokers, obese, and show an onset dependent on winter but not low-temperature in a region with a warm climate.
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Affiliation(s)
- Chiao-Yu Shih
- Department of Physical Therapy, Tzu Chi University, Hualien 97004, Taiwan;
| | - Min-Liang Chu
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan; (M.-L.C.); (T.-C.H.)
| | - Tsung-Cheng Hsieh
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan; (M.-L.C.); (T.-C.H.)
| | - Han-Lin Chen
- Center for General Education, Tzu Chi University of Science and Technology, Hualien 97004, Taiwan;
| | - Chih-Wei Lee
- Department of Physical Therapy, Tzu Chi University, Hualien 97004, Taiwan;
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan; (M.-L.C.); (T.-C.H.)
- Correspondence:
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121
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Kuzmenko NV, Pliss MG, Galagudza MM, Tsyrlin VA. Effects of Hyper- and Hypothermia on Hemodynamic Parameters in People of Different Age Groups: Meta-Analysis. ADVANCES IN GERONTOLOGY 2020. [DOI: 10.1134/s2079057020020095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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122
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Xia L, Huang L, Feng X, Xiao J, Wei X, Yu X. Chronobiological patterns of acute aortic dissection in central China. Heart 2020; 107:heartjnl-2020-317009. [PMID: 32660983 PMCID: PMC7873417 DOI: 10.1136/heartjnl-2020-317009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Acute aortic dissection (AAD) is a life-threatening emergency with poor clinical outcomes. Understanding the chronological patterns of AAD onset would be helpful for identifying the triggers of AAD and preventing this catastrophic event. METHODS We collected data from 2048 patients diagnosed with AAD at Tongji Hospital (Wuhan, China) from 2011 to 2018. The χ2 test was used to determine whether a specific period had significantly different seasonal/weekly distributions from other periods. Fourier models were used to analyse the rhythmicity in monthly/circadian distribution. RESULTS The mean age was 53.4±10.9 years, and 1161 patients (56.7%) were under 55 years. One thousand six hundred fifty-seven patients (80.9%) were male, and 935 cases (45.7%) were type A dissections. The proportions of patients with comorbid hypertension/diabetes were 60.3% (1234 cases) and 1.8% (36 cases), respectively. A peak was identified in colder periods (winter/December) and a trough in warmer periods (summer/June). No significant variation was observed in weekly distribution. Fourier analysis showed a statistically significant circadian variation (p<0.001) with a nocturnal trough in 2:00-3:00, a morning peak in 9:00-10:00, and an afternoon peak in 16:00-17:00. Subgroup analyses identified circadian rhythmicity in all subgroups except for the female group and younger group (younger than 55 years). CONCLUSION Our results confirmed that the onset of AAD exhibits significant seasonal, monthly and circadian patterns. Patients with AAD with different Stanford-type dissections, sexes, ages and hypertension statuses could present different circadian variations. These findings may provide novel perspectives for identifying the triggers of AAD and better preventing this catastrophic event.
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Affiliation(s)
- Liangtao Xia
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lu Huang
- Tongji Hospital, Tongji Medical College,Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xin Feng
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiewen Xiao
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiang Wei
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, Hubei, China
- NHC Key Laboratory of Organ Transplantation, Wuhan, Hubei, China
- Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, Hubei, China
| | - Xinyu Yu
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Kurihara O, Takano M, Yamamoto E, Yonetsu T, Kakuta T, Soeda T, Yan BP, Crea F, Higuma T, Kimura S, Minami Y, Adriaenssens T, Boeder NF, Nef HM, Kim CJ, Thondapu V, Kim HO, Russo M, Sugiyama T, Fracassi F, Lee H, Mizuno K, Jang IK. Seasonal Variations in the Pathogenesis of Acute Coronary Syndromes. J Am Heart Assoc 2020; 9:e015579. [PMID: 32611221 PMCID: PMC7670515 DOI: 10.1161/jaha.119.015579] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Seasonal variations in acute coronary syndromes (ACS) have been reported, with incidence and mortality peaking in the winter. However, the underlying pathophysiology for these variations remain speculative. Methods and Results Patients with ACS who underwent optical coherence tomography were recruited from 6 countries. The prevalence of the 3 most common pathologies (plaque rupture, plaque erosion, and calcified plaque) were compared between the 4 seasons. In 1113 patients with ACS (885 male; mean age, 65.8±11.6 years), the rates of plaque rupture, plaque erosion, and calcified plaque were 50%, 39%, and 11% in spring; 44%, 43%, and 13% in summer; 49%, 39%, and 12% in autumn; and 57%, 30%, and 13% in winter (P=0.039). After adjusting for age, sex, and other coronary risk factors, winter was significantly associated with increased risk of plaque rupture (odds ratio [OR], 1.652; 95% CI, 1.157-2.359; P=0.006) and decreased risk of plaque erosion (OR, 0.623; 95% CI, 0.429-0.905; P=0.013), compared with summer as a reference. Among patients with rupture, the prevalence of hypertension was significantly higher in winter (P=0.010), whereas no significant difference was observed in the other 2 groups. Conclusions Seasonal variations in the incidence of ACS reflect differences in the underlying pathobiology. The proportion of plaque rupture is highest in winter, whereas that of plaque erosion is highest in summer. A different approach may be needed for the prevention and treatment of ACS depending on the season of its occurrence. Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT03479723.
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Affiliation(s)
- Osamu Kurihara
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
| | - Masamichi Takano
- Cardiovascular Center Nippon Medical School Chiba Hokusoh Hospital Inzai, Chiba Japan
| | - Erika Yamamoto
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
| | - Taishi Yonetsu
- Department of Interventional Cardiology Tokyo Medical and Dental University Tokyo Japan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine Nara Medical University Nara Japan
| | - Bryan P Yan
- Division of Cardiology Department of Medicine and Therapeutics Prince of Wales Hospital Chinese University of Hong Kong Hong Kong SAR China
| | - Filippo Crea
- Fondazione Policlinico Universitario A Gemelli IRCCS Roma Italy
| | - Takumi Higuma
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kawasaki Kanagawa Japan
| | - Shigeki Kimura
- Division of Cardiology Kameda Medical Center Chiba Japan
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine Kitasato University School of Medicine Sagamihara Japan
| | - Tom Adriaenssens
- Department of Cardiovascular Medicine University Hospitals Leuven Leuven Belgium
| | | | - Holger M Nef
- Department of Cardiology University of Giessen Germany
| | - Chong Jin Kim
- Department of Cardiology Kyung Hee University Hospital Seoul Korea
| | - Vikas Thondapu
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
| | - Hyung Oh Kim
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
| | - Michele Russo
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
| | - Tomoyo Sugiyama
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
| | - Francesco Fracassi
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
| | - Hang Lee
- Biostatistics Center Massachusetts General Hospital Harvard Medical School Boston MA
| | | | - Ik-Kyung Jang
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA.,Department of Cardiology Kyung Hee University Hospital Seoul Korea
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Mohammad KN, Chan EYY, Wong MCS, Goggins WB, Chong KC. Ambient temperature, seasonal influenza and risk of cardiovascular disease in a subtropical area in Southern China. ENVIRONMENTAL RESEARCH 2020; 186:109546. [PMID: 32334173 DOI: 10.1016/j.envres.2020.109546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Given the regular winter recurrence of influenza epidemics and the biologically plausible association between seasonal influenza and cardiovascular events, researchers assumed a valid and reliable influenza forecast could envision the timing and burden of winter surge in cardiovascular (CVD) hospitalizations. This, however, is well justified only in temperate regions. In this study, we aim to investigate the temporal association between ambient temperature, seasonal influenza and risk of cardiovascular events in a subtropical city. METHODS Generalized additive model was used in conjunction with distributed-lag non-linear model of quasi-Poisson family to estimate the association of interest with daily CVD admissions as outcome and daily influenza admissions as predictor, while controlling for meteorological factors (i.e. temperature, relative humidity, wind speed and total rainfall) and respiratory pollutants (i.e. nitrogen dioxide, sulphur dioxide, ozone and PM10). Results were expressed in the form of relative risk (RR). RESULTS Using median as the reference value, a U-shaped association was observed between CVD admissions and temperature. A slight decrease in RR was detected mainly towards the lower end of the temperature scale after adjusting for influenza admissions. Risk of CVD admission was found to be positively associated with the number of influenza hospitalization cases; this association remained consistent and statistically significant across subgroups of age except for those aged 5-49 years. CONCLUSION The slight reduction in CVD admission risk towards the lower end of the temperature scale after controlling for influenza activity might be attributed to the winter peaks of influenza, meaning that the effect of low temperature on CVD admissions might be partly mediated by influenza infection. In summary, this study reassures us that ambient temperature is independently associated with CVD hospital admissions and offers support for a positive association between seasonal influenza activity and cardiovascular events in Hong Kong.
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Affiliation(s)
- Kirran N Mohammad
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Emily Ying Yang Chan
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Martin Chi Sang Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - William Bernard Goggins
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Chun Chong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, China; Centre for Health System and Policy Research, The Chinese University of Hong Kong, Hong Kong, China.
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125
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Lu P, Xia G, Zhao Q, Xu R, Li S, Guo Y. Temporal trends of the association between ambient temperature and hospitalisations for cardiovascular diseases in Queensland, Australia from 1995 to 2016: A time-stratified case-crossover study. PLoS Med 2020; 17:e1003176. [PMID: 32692738 PMCID: PMC7373260 DOI: 10.1371/journal.pmed.1003176] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 06/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In the context of global warming, studies have turned to assess the temporal trend of the association between temperature and health outcomes, which can be used to reflect whether human beings have adapted to the local temperature. However, most studies have only focused on hot temperature and mortality. We aim to investigate the temporal variations in the association between ambient temperature and hospitalisations for cardiovascular diseases in Queensland, Australia from 1995 to 2016. METHODS AND FINDINGS We obtained data on 1,855,717 cardiovascular hospitalisations (mean age: 65.9 years, 42.7% female) from all 443 postal areas in Queensland, Australia between January 1, 1995 and December 31, 2016. Grid-level meteorological data were downloaded from scientific information for landowners. We used a time-stratified case-crossover design fitted with a conditional quasi-Poisson regression model and time-varying distributed lag nonlinear model (DLNM) to evaluate the association between temperature and cardiovascular hospitalisations and the temporal trends of the associations. Stratified analyses were performed in different age, sex, and climate zones. In all groups, relative risks (RRs) of cardiovascular hospitalisations associated with high temperatures (heat effects) increased, but cold effects showed a decreasing trend from 1995 to 2016. The increasing magnitude of heat effects was larger (p = 0.002) in men than in women and larger (p < 0.001) in people aged ≤69 years than in those aged ≥70 years. There was no apparent difference amongst different climate zones. The study was limited by the switch from ICD-9 to ICD-10 coding systems, by being unable to separate first-time hospitalisation from repeated hospitalisations, and possibly by confounding by air pollution or by influenza infections. CONCLUSION The impacts of cold temperatures on cardiovascular hospitalisations have decreased, but the impacts of high temperatures have increased in Queensland, Australia. The findings highlight that Queensland people have adapted to the impacts of cold temperatures, but not high temperatures. The burden of cardiovascular hospitalisations due to high temperatures is likely to increase in the context of global warming.
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Affiliation(s)
- Peng Lu
- School of Public Health and Management, Binzhou Medical University, Yantai, Shandong, China
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Guoxin Xia
- School of Medicine, Binzhou Medical University, Yantai, Shandong, China
| | - Qi Zhao
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rongbin Xu
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yuming Guo
- School of Public Health and Management, Binzhou Medical University, Yantai, Shandong, China
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Figueroa JD, Brennan PM, Theodoratou E, Poon MTC, Purshouse K, Din FVN, Jin K, Mesa-Eguiagaray I, Dunlop MG, Hall PS, Cameron D, Wild SH, Sudlow CLM. Distinguishing between direct and indirect consequences of covid-19. BMJ 2020; 369:m2377. [PMID: 32540857 DOI: 10.1136/bmj.m2377] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | | | | | | | | | - Kai Jin
- University of Edinburgh, Edinburgh, UK
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127
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Association between ambient temperature and hypertensive disorders in pregnancy in China. Nat Commun 2020; 11:2925. [PMID: 32522990 PMCID: PMC7286884 DOI: 10.1038/s41467-020-16775-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 05/21/2020] [Indexed: 02/05/2023] Open
Abstract
Hypertensive disorders in pregnancy (HDPs) are leading perinatal diseases. Using a national cohort of 2,043,182 pregnant women in China, we evaluated the association between ambient temperatures and HDP subgroups, including preeclampsia or eclampsia, gestational hypertension, and superimposed preeclampsia. Under extreme temperatures, very cold exposure during preconception (12 weeks) increases odds of preeclampsia or eclampsia and gestational hypertension. Compared to preconception, in the first half of pregnancy, the impact of temperature on preeclampsia or eclampsia and gestational hypertension is opposite. Cold exposure decreases the odds, whereas hot exposure increases the odds. Under average temperatures, a temperature increase during preconception decreases the risk of preeclampsia or eclampsia and gestational hypertension. However, in the first half of pregnancy, temperature is positively associated with a higher risk. No significant association is observed between temperature and superimposed preeclampsia. Here we report a close relationship exists between ambient temperature and preeclampsia or eclampsia and gestational hypertension. Hypertensive disorders in pregnancy are prevalent perinatal diseases. Here the authors report an association between ambient temperature before or after conception and risk of preeclampsia or eclampsia and gestational hypertension.
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128
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Lennon MJ, Neuen DR, Godwin MR. No 'Christmas holiday effect' in Australia for cardiovascular and stroke mortality. Public Health 2020; 182:190-192. [PMID: 32361029 DOI: 10.1016/j.puhe.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/28/2020] [Accepted: 03/06/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Cardiovascular events and mortality have shown a higher incidence within the Christmas holiday period in previous studies and in the northern and southern hemisphere. Our study aimed to assess changes in cardiovascular and stroke mortality variation around the Christmas period in Australia. STUDY DESIGN The study design is a population-based case-control study. METHODS Daily mortality data attributed to stroke and cardiovascular was compiled from Australia between 1989 and 2015, amounting to approximately 700,000 and 250,000 deaths, respectively. A locally weighted polynomial regression line was used to estimate expected mortality rates during that period and compared with actual results. RESULTS There was a non-significant increase of 1.08% (P = 0.35) and 0.20% (P = 0.87) for coronary heart disease and stroke mortality, respectively, in the Christmas holiday period. CONCLUSIONS There is no evidence of an increase in cardiovascular and stroke mortality in the Christmas holiday period in Australia.
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Affiliation(s)
- M J Lennon
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Wagga Wagga, NSW, 2650, Australia; Wagga Wagga Rural Clinical School, School of Medicine Sydney, University of Notre Dame Australia, PO Box 5050, Wagga Wagga NSW, 2650, Australia; Wagga Wagga Base Hospital, Murrumbidgee Local Health District, PO Box 5050, Wagga Wagga, NSW, 2650, Australia.
| | - D R Neuen
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Wagga Wagga, NSW, 2650, Australia; Wagga Wagga Rural Clinical School, School of Medicine Sydney, University of Notre Dame Australia, PO Box 5050, Wagga Wagga NSW, 2650, Australia; Wagga Wagga Base Hospital, Murrumbidgee Local Health District, PO Box 5050, Wagga Wagga, NSW, 2650, Australia
| | - M R Godwin
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Wagga Wagga, NSW, 2650, Australia; Wagga Wagga Rural Clinical School, School of Medicine Sydney, University of Notre Dame Australia, PO Box 5050, Wagga Wagga NSW, 2650, Australia; Wagga Wagga Base Hospital, Murrumbidgee Local Health District, PO Box 5050, Wagga Wagga, NSW, 2650, Australia
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Higher admission rates and in-hospital mortality for acute type A aortic dissection during Influenza season: a single center experience. Sci Rep 2020; 10:4723. [PMID: 32170215 PMCID: PMC7070060 DOI: 10.1038/s41598-020-61717-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/02/2020] [Indexed: 11/26/2022] Open
Abstract
Triggering events for acute aortic dissections are incompletely understood. We sought to investigate whether there is an association between admission for acute type A aortic dissection (ATAAD) to the University of Michigan Medical Center and the reported annual influenza activity by the Michigan Department of Health and Human Services. From 1996–2019 we had 758 patients admitted for ATAAD with 3.1 admissions per month during November-March and 2.5 admissions per month during April-October (p = 0.01). Influenza reporting data by the Michigan Department of Health and Human Services became available in 2009. ATAAD admissions for the period 2009–2019 (n = 455) were 4.8 cases/month during peak influenza months compared to 3.5 cases/month during non-peak influenza months (p = 0.001). ATAAD patients admitted during influenza season had increased in-hospital mortality (11.0% vs. 5.8%, p = 0.024) and increased 30-day mortality (9.7 vs. 5.4%, p = 0.048). The results point to higher admission rates for ATAAD during months with above average influenza rates. Future studies need to investigate whether influenza virus infection affects susceptibility for aortic dissection, and whether this risk can be attenuated with the annual influenza vaccine in this patient population.
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131
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Kario K, Chia Y, Sukonthasarn A, Turana Y, Shin J, Chen C, Buranakitjaroen P, Nailes J, Hoshide S, Siddique S, Sison J, Soenarta AA, Sogunuru GP, Tay JC, Teo BW, Zhang Y, Park S, Minh HV, Tomitani N, Kabutoya T, Verma N, Wang T, Wang J. Diversity of and initiatives for hypertension management in Asia-Why we need the HOPE Asia Network. J Clin Hypertens (Greenwich) 2020; 22:331-343. [PMID: 31773883 PMCID: PMC8029896 DOI: 10.1111/jch.13733] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 12/21/2022]
Abstract
The Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network was set up to improve the management of hypertension in Asia with the ultimate goal of achieving "zero" cardiovascular events. Asia is a diverse continent, and the prevalence of hypertension has increased over the last 30 years. There are a number of Asia-specific features of hypertension and hypertension-related cardiovascular complications, which means that a region-specific approach is needed. White-coat hypertension will become more of an issue over time as Asian populations age, and masked hypertension is more prevalent in Asian than in Western countries. Identifying and treating masked hypertension is important to reduce cardiovascular risk. Abnormal patterns of blood pressure (BP) variability common in Asia include exaggerated early morning BP surge and nocturnal hypertension. These are also important cardiovascular risk factors that need to be managed. Home blood pressure monitoring (HBPM) is an important tool for detecting white-coat and masked hypertension, and monitoring BP variability, and practices in Asia are variable. Use of HBPM is important given the Asia-specific features of hypertension, and strategies are needed to improve and standardize HBPM usage. Development of HBPM devices capable of measuring nocturnal BP along with other information and communication technology-based strategies are key developments in the widespread implementation of anticipation medicine strategies to detect and prevent cardiovascular events in patients with hypertension. Region-wide differences in hypertension prevalence, control, and management practices in Asia highlight the importance of information sharing to facilitate best practices.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Yook‐Chin Chia
- Department of Medical SciencesSchool of Healthcare and Medical SciencesSunway UniversityBandar SunwayMalaysia
- Department of Primary Care MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Apichard Sukonthasarn
- Cardiology DivisionDepartment of Internal MedicineFaculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Yuda Turana
- Faculty of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia
| | - Jinho Shin
- Faculty of Cardiology ServiceHanyang University Medical CenterSeoulKorea
| | - Chen‐Huan Chen
- Department of MedicineSchool of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
| | - Peera Buranakitjaroen
- Department of MedicineFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Jennifer Nailes
- University of the East Ramon Magsaysay Memorial Medical Center Inc.Quezon CityPhilippines
| | - Satoshi Hoshide
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | | | - Jorge Sison
- Section of CardiologyDepartment of MedicineMedical Center ManilaManilaPhilippines
| | - Arieska Ann Soenarta
- Department of Cardiology and Vascular MedicineFaculty of MedicineUniversity of Indonesia‐National Cardiovascular Center, Harapan KitaJakartaIndonesia
| | - Guru Prasad Sogunuru
- MIOT International HospitalChennaiIndia
- College of Medical SciencesKathmandu UniversityBharatpurNepal
| | - Jam Chin Tay
- Department of General MedicineTan Tock Seng HospitalSingapore CitySingapore
| | - Boon Wee Teo
- Division of NephrologyDepartment of MedicineYong Loo Lin School of MedicineNational University of SingaporeSingapore CitySingapore
| | - Yu‐Qing Zhang
- Divisions of Hypertension and Heart FailureFu Wai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Sungha Park
- Division of CardiologyCardiovascular HospitalYonsei Health SystemSeoulKorea
| | - Huynh Van Minh
- Department of Internal MedicineUniversity of Medicine and PharmacyHue UniversityHue CityVietnam
| | - Naoko Tomitani
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Tomoyuki Kabutoya
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Narsingh Verma
- Department of PhysiologyKing George's Medical UniversityLucknowIndia
| | - Tzung‐Dau Wang
- Department of Internal MedicineCardiovascular Center and Division of CardiologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Ji‐Guang Wang
- Department of HypertensionCentre for Epidemiological Studies and Clinical Trialsthe Shanghai Institute of HypertensionShanghai Key Laboratory of HypertensionRuijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
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132
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Dent E, Ambagtsheer RC, Beilby J, Stewart S. Editorial: Frailty and Seasonality. J Nutr Health Aging 2020; 24:547-549. [PMID: 32510104 PMCID: PMC7164411 DOI: 10.1007/s12603-020-1367-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 01/10/2023]
Affiliation(s)
- E Dent
- Elsa Dent, Torrens University Australia, Adelaide, South Australia, Australia,
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133
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Ahtela E, Oksi J, Sipilä J, Rautava P, Kytö V. Occurrence of fatal infective endocarditis: a population-based study in Finland. BMC Infect Dis 2019; 19:987. [PMID: 31752727 PMCID: PMC6873758 DOI: 10.1186/s12879-019-4620-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/07/2019] [Indexed: 11/16/2022] Open
Abstract
Background Infective endocarditis (IE) is a serious mainly bacterial infection associated with high mortality. Epidemiology of fatal IE is however largely unknown. We studied occurrence and trends of fatal IE in a population-based setting. Methods All adults (≥18 years of age) who deceased due to IE in Finland during 2004–2016 were studied. Data was collected from the nationwide, obligatory Cause of Death Registry. Background population consisted of 28,657,870 person-years and 651,556 deaths. Results Infective endocarditis contributed to death in 754 cases and was the underlying cause of death in 352 cases. The standardized incidence rate of deaths associated with IE was 1.42 (95% confidence interval (CI): 1.32–1.52) per 100,000 person-years. Incidence rate increased progressively with aging from 50 years of age. Men had a two-fold risk of acquiring fatal infective endocarditis compared to women (risk ratio (RR) 1.95; 95% CI: 1.71–2.22; P < 0.0001). On average, IE contributed to 1.16 (95% CI: 1.08–1.24) out of 1000 deaths in general adult population. The proportionate amount of deaths with IE was highest in population aged < 40 years followed by gradual decrease with aging. Incidence rate and proportion of deaths caused by IE remained stable during the study period. Conclusions Our study describes for the first time the population-based epidemiology of fatal IE in adults. Men had a two-fold risk of acquiring fatal IE compared to women. Although occurrence of fatal IE increased with aging, the proportion of deaths to which IE contributed was highest in young adult population.
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Affiliation(s)
- Elina Ahtela
- Heart Center, Turku University Hospital and University of Turku, PO Box 52, 20521, Turku, Finland. .,Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland.
| | - Jarmo Oksi
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Jussi Sipilä
- Siun sote, North Karelia Central Hospital, Joensuu, Finland.,Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.,Department of Neurology, University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, PO Box 52, 20521, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Administrative Center, Hospital District of Southwest Finland, Turku, Finland
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A Case-Crossover Study to Investigate the Effects of Atmospheric Particulate Matter Concentrations, Season, and Air Temperature on Accident and Emergency Presentations for Cardiovascular Events in Northern Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234627. [PMID: 31766396 PMCID: PMC6926530 DOI: 10.3390/ijerph16234627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/11/2019] [Accepted: 11/15/2019] [Indexed: 12/05/2022]
Abstract
Atmospheric particulate matter (PM) has multiple adverse effects on human health, high temperatures are also associated with adverse health outcomes, and the frequency of cardiovascular events (CVEs) varies with season. We investigated a hypothesized increase in PM-related accident and emergency (A&E) presentations for CVE with high temperature, warm season, days of high influenza incidence, and in people with a cancer diagnosis, using a time-stratified case-crossover study design. Outcomes were associations of A&E presentation for CVE with atmospheric PM ≤ 10 μm (PM10), season, and air temperature. PM10 levels in the municipality of residence (exposure variable) were estimated by modeling data from local monitoring stations. Conditional logistic regression models estimated odds ratios (OR) with 95% confidence intervals (CI) for presentations in relation to supposed influencers, adjusting for confounders. Study participants were all who presented at the A&E of a large hospital near Milan, Italy, for a CVE (ICD-9: 390–459) from 1st January 2014 to 31st December 2015. There were 1349 A&E presentations for CVE in 2014–2015 and 5390 control days. Risk of A&E presentation was significantly increased on hot days with OR 1.34 (95%CI 1.05–1.71) per 10 μg/m3 PM10 increment (as mean PM10 on day of presentation, and 1 and 2 days before (lags 0–2)), and (for lag 0) in autumn (OR 1.23, 95%CI 1.09–1.37) and winter (OR 1.18, 95%CI 1.01–1.38). Risks were also significantly increased when PM10 was on lag 1, in people with a cancer diagnosis in the spring and summer months (1.88, 95%CI 1.05–3.37), and on days (lags 0–2) of high influenza incidence (OR 2.34, 95%CI 1.01–5.43). PM10 levels exceeded the 50 μg/m3 “safe” threshold recommended by the WHO and Italian legislation for only 3.8% of days during the warm periods of 2014–2015. Greater risk of A&E presentation for CVE in periods of high PM10 and high temperature suggests that “safe” thresholds for PM10 should be temperature-dependent and that the adverse effects of PM10 will increase as temperatures increase due to climate change.
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135
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Iwagami M, Moriya H, Doi K, Yasunaga H, Isshiki R, Sato I, Mochida Y, Ishioka K, Ohtake T, Hidaka S, Noiri E, Kobayashi S. Seasonality of acute kidney injury incidence and mortality among hospitalized patients. Nephrol Dial Transplant 2019; 33:1354-1362. [PMID: 29462342 DOI: 10.1093/ndt/gfy011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/06/2018] [Indexed: 01/08/2023] Open
Abstract
Background Understanding disease seasonality is important for improving clinical practice, hospital resource utilization and community-based preventive care. However, no studies have investigated the seasonality of acute kidney injury (AKI). Methods In the Tokushukai Medical Database, which includes 38 Japanese community hospitals, we identified hospitalized patients with AKI based on the Kidney Disease: Improving Global Outcomes serum creatinine criteria from January 2012 to December 2014. We plotted the number and proportion of patients with AKI among hospitalized patients by month of hospital admission. Subgroup analyses were conducted by the admission diagnosis category, timing of AKI diagnosis and age. We also examined the association between month of hospital admission and AKI, adjusting for patient characteristics and AKI risk factors. Finally, we assessed seasonal variations in disease severity and 30-day mortality of patients with AKI. Results We identified 81 279 (14.6%) patients with AKI among 555 940 hospitalized patients. The proportion of patients with AKI was highest in January (16.7%) and lowest in June (13.4%). Subgroup analyses suggested that the seasonality of AKI incidence was driven by community-acquired AKI associated with the admission diagnosis of cardiovascular and pulmonary diseases among older patients. The adjusted odds ratio for AKI (January versus June) was 1.24 (95% confidence interval, 1.17-1.31). Patients with AKI showed a larger number of failing organs in winter, and their 30-day mortality was 16.4% in spring, 14.5% in summer, 15.6% in autumn and 18.4% in winter. Conclusion AKI is more common among hospitalized patients and patients with AKI are more severely ill in winter.
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Affiliation(s)
- Masao Iwagami
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidekazu Moriya
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, University of Tokyo Hospital, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Rei Isshiki
- Department of Nephrology and Endocrinology, University of Tokyo Hospital, Tokyo, Japan
| | - Izumi Sato
- Center for Pharmacoepidemiology and Treatment Science, Rutgers, The State University of New Jersey, NJ, USA.,Department of Pharmacoepidemiology, Kyoto University, Kyoto, Japan
| | - Yasuhiro Mochida
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kunihiro Ishioka
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Takayasu Ohtake
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Sumi Hidaka
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Eisei Noiri
- Department of Nephrology and Endocrinology, University of Tokyo Hospital, Tokyo, Japan
| | - Shuzo Kobayashi
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
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Boussoussou M, Boussoussou N, Merész G, Rakovics M, Entz L, Nemes A. Atmospheric fronts as minor cardiovascular risk factors, a new approach to preventive cardiology. J Cardiol 2019; 75:196-202. [PMID: 31439421 DOI: 10.1016/j.jjcc.2019.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/09/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cardiovascular diseases are the number one cause of death globally and represent 31% of all global deaths. The aim of our study was to determine the influence of front effects on acute cardiovascular diseases (ACVDs). METHODS We obtained all ACVD admissions in a Central-European region, Hungary, Budapest. A time-series analysis was applied to 6499 morbidity cases during a five-year period (2009-2013). Poisson-regression model was used and adjusted for air temperature, pressure, humidity, wind velocity, their interactions and seasonality to assess the association of fronts and ACVDs. RESULTS There is a positive significant association between ACVDs and a cold front effect lagged by one day (p=0.018) with a relative risk (RR) of 1.095 [95% CI (1.021,1.181)]. Our findings show that among patient subgroups with major cardiovascular risk factors (hypertension, diabetes, hyperlipidemia, history of CVDs) the patterns are similar, but occluded fronts also have a significant effect. CONCLUSION Atmospheric fronts could play an important role in the pathogenesis of ACVDs. Our findings might help to provide a better understanding about fronts as minor cardiovascular risk factors and to organize medical prevention more effectively. Our research project may become a basis of a new field of preventive cardiovascular medicine in the future.
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Affiliation(s)
| | - Nora Boussoussou
- Department of Vascular Surgery, Semmelweis University, Budapest, Hungary
| | - Gergő Merész
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Márton Rakovics
- Department of Statistics, ELTE University, Budapest, Hungary
| | - László Entz
- Department of Vascular Surgery, Semmelweis University, Budapest, Hungary
| | - Attila Nemes
- Department of Vascular Surgery, Semmelweis University, Budapest, Hungary
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137
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Pradhan B, Kjellstrom T, Atar D, Sharma P, Kayastha B, Bhandari G, Pradhan P. Heat Stress Impacts on Cardiac Mortality in Nepali Migrant Workers in Qatar. Cardiology 2019; 143:37-48. [DOI: 10.1159/000500853] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/02/2019] [Indexed: 11/19/2022]
Abstract
Background: Qatar is a major destination country for Nepali migrant workers (NMWs; main age range 25–35 years) in the construction trade. These 120,000+ NMWs are exposed to various occupational hazards, including excessive heat, and 3–4 workers die each week. Our study aimed to show whether heat exposure caused deaths. Methods: The worker population and mortality data of NMWs were retrieved from government institutions in Nepal. Heat exposure was assessed by monthly estimates of daily wet bulb globe temperature (WBGT), for in-shade conditions, from data collected at the Doha weather station from 2009 to 2017. Working in the sun during the middle of the day would add 2–3°C to the in-shade WBGT values. Daily deaths and their causes were obtained from the records of the Foreign Employment Promotion Board (FEPB) in Nepal, 2009–2017. Interviews with returning NMWs about their working conditions and the impacts of these conditions added information. The association between the heat variable and mortality was tested with standard statistical methods. Results: The average annual death rate for NMWs in Qatar was 150 deaths/100,000. According to interviews, the majority of NMWs were found working in high WBGT (>31°C) each working day during hot months. The major cause of these deaths was recorded as cardiovascular problems (cardiovascular disease; CVD). Unfortunately, the causes of death were poorly described, and many deaths were listed as “cardiac arrest.” We included these deaths in the broader category of “cardiovascular causes.” There was a strong correlation between average monthly afternoon heat levels (WBGT) and CVD mortality. It is likely that a large proportion of these CVD deaths during hot months were due to serious heat stroke. Global studies show that approximately 15% of deaths in the age group 25–35 years are due to CVD causes. However, in this NMW population, the figures were 22% during the cool season and 58% during the hot season. Conclusions: The increased CVD mortality during hot periods is most likely due to severe heat stress. As many as 200 of the 571 CVD deaths during 2009–2017 could have been prevented if effective heat protection had been implemented as a part of local occupational health and safety programs. There is an urgent need for protection against such heat effects among NMWs, and rising temperatures from ongoing climate change are further increasing the health risks. Cause of death records for workers dying in hot conditions should be more precise than “cardiac arrest.”
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138
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Lack of seasonality in occurrence of pericarditis, myocarditis, and endocarditis. Ann Epidemiol 2019; 37:77-80. [PMID: 31431396 DOI: 10.1016/j.annepidem.2019.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 06/17/2019] [Accepted: 07/06/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE The etiology of pericarditis, myocarditis, and endocarditis is predominantly infectious, and infections often show seasonal variation. Little is known, however, about seasonal patterns in these cardiopathies. METHODS Using Danish health care registries, we identified all patients with a first-time hospital-based diagnosis of pericarditis, myocarditis, or endocarditis between 1994 and 2016. We estimated peak-to-trough ratios from fitted sine curves to measure the intensity of seasonal variation in occurrence during the study period. Because randomness will lead to small apparent seasonal patterns, we also conducted a plasmode simulation to assess the degree of seasonality that randomness would produce. RESULTS Crude peak-to-trough ratios of monthly frequencies summarized over a year were small. We estimated a peak-to-trough ratio of 1.10 (95% confidence interval [CI], 1.05-1.14) for pericarditis, 1.11 (95% CI, 1.02-1.21) for myocarditis, and 1.01 (95% CI, 1.00-1.07) for endocarditis. The simulated mean peak-to-trough ratios found after randomly reassigning the monthly frequencies within each year were 1.04 (95% CI, 1.00-1.09) for pericarditis, 1.04 (95% CI, 1.00-1.13) for myocarditis, and 1.04 (95% CI, 1.00-1.10), for endocarditis. CONCLUSION The data indicate no important seasonal variation in the occurrence of pericarditis, myocarditis, and endocarditis in Denmark between 1994 and 2016.
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139
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Skajaa N, Horváth-Puhó E, Adelborg K, Prandoni P, Rothman KJ, Sørensen HT. Venous Thromboembolism in Denmark: Seasonality in Occurrence and Mortality. TH OPEN 2019; 3:e171-e179. [PMID: 31259300 PMCID: PMC6598086 DOI: 10.1055/s-0039-1692399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/02/2019] [Indexed: 11/17/2022] Open
Abstract
Background
Many cardiovascular conditions exhibit seasonality in occurrence and mortality, but little is known about the seasonality of venous thromboembolism.
Methods
Using Danish registries, we identified all patients with deep vein thrombosis, pulmonary embolism, splanchnic vein thrombosis, cerebral vein thrombosis, and retinal vein thrombosis during 1977–2016. We tallied monthly deaths occurring within 90 days of the venous thromboembolism diagnosis. We estimated peak-to-trough ratios and timing of the peak of both diagnoses and deaths summed over all years of the study period. The departure from 1.0 of the peak-to-trough ratio measures the intensity of any seasonal pattern.
Results
We estimated a peak-to-trough ratio of 1.09 (95% confidence interval: 1.07–1.11) for deep vein thrombosis and 1.22 (1.19–1.24) for pulmonary embolism occurrence. The peak-to-trough ratios for splanchnic vein thrombosis, cerebral vein thrombosis, and retinal vein thrombosis occurrence were 1.10 (1.01–1.20), 1.19 (1.00–1.40), and 1.12 (1.07–1.17), respectively. The occurrence of all conditions peaked during winter or fall. In time trend analyses, the peak-to-trough ratio increased considerably for splanchnic vein thrombosis, cerebral vein thrombosis, and retinal vein thrombosis occurrence. In associated mortality, the peak-to-trough ratio for deep vein thrombosis was larger (1.15, 1.07–1.23) than that for pulmonary embolism (1.04, 1.01–1.08).
Discussion
Excess winter risks were modest, but more marked for pulmonary embolism occurrence than for deep vein thrombosis occurrence. The seasonal pattern intensified throughout the study period for splanchnic vein thrombosis, cerebral vein thrombosis, and retinal vein thrombosis. The winter peak in mortality following pulmonary embolism was smaller than that for deep vein thrombosis.
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Affiliation(s)
- Nils Skajaa
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | | | - Kenneth J Rothman
- RTI Health Solutions, Research Triangle Institute, Research Triangle Park, North Carolina, United States.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Sharif Nia H, Chan YH, Froelicher ES, Pahlevan Sharif S, Yaghoobzadeh A, Jafari A, Goudarzian AH, Pourkia R, Haghdoost AA, Arefinia F, Nazari R. Weather fluctuations: predictive factors in the prevalence of acute coronary syndrome. Health Promot Perspect 2019; 9:123-130. [PMID: 31249799 PMCID: PMC6588813 DOI: 10.15171/hpp.2019.17] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 02/10/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Meteorological parameters and seasonal changes can play an important role in the occurrence of acute coronary syndrome (ACS). However, there is almost no evidence on a national level to suggest the associations between these variables and ACS in Iran. We aim to identify the meteorological parameters and seasonal changes in relationship to ACS. Methods: This retrospective cross-sectional study was conducted between 03/19/2015 to 03/18/2016 and used documents and records of patients with ACS in Mazandaran ProvinceHeart Center, Iran. The following definitive diagnostic criteria for ACS were used: (1) existence of cardiac enzymes (CK or CK-MB) above the normal range; (2) Greater than 1 mm ST-segment elevation or depression; (3) abnormal Q waves; and (4) manifestation of troponin enzyme in the blood. Data were collected daily, such as temperature (Celsius) changes, wind speed and its direction, rainfall, daily evaporation rate; number of sunny days, and relative humidity were provided by the Meteorological Organization of Iran. Results: A sample of 2,054 patients with ACS were recruited. The results indicated the highest ACS events from March to May. Generally, wind speed (18 PM) [IRR = 1.051 (95% CI: 1.019 to1.083), P=0.001], daily evaporation [IRR = 1.039 (95% CI: 1.003 to 1.077), P=0.032], daily maximum (P<0.001) and minimum (P=0.003) relative humidity was positively correlated withACS events. Also, negatively correlated variables were daily relative humidity (18 PM) [IRR =0.985 (95% CI: 0.978 to 0.992), P<0.001], and daily minimum temperature [IRR = 0.942 (95%CI: 0.927 to 0.958), P<0.001]. Conclusion: Climate changes were found to be significantly associated with ACS; especially from cold weather to hot weather in March, April and May. Further research is needed to fully understand the specific conditions and cold exposures.
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Affiliation(s)
- Hamid Sharif Nia
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery Amol, Mazandaran University of Medical Sciences, Sari, Iran
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Erika Sivarajan Froelicher
- Department of Physiological Nursing, Department of Epidemiology & Biostatistics, University of California San Francisco, California, USA
| | | | | | - Azar Jafari
- Department of Nursing, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amir Hossein Goudarzian
- Faculty of Nursing, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roghiyeh Pourkia
- Department of Cardiology, Cardiovascular Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Ali Akbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Farhad Arefinia
- School of Nursing and Midwifery Amol, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roghieh Nazari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery Amol, Mazandaran University of Medical Sciences, Sari, Iran
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Stewart S, Moholdt TT, Burrell LM, Sliwa K, Mocumbi AO, McMurray JJ, Keates AK, Hawley JA. Winter Peaks in Heart Failure: An Inevitable or Preventable Consequence of Seasonal Vulnerability? Card Fail Rev 2019; 5:83-85. [PMID: 31179017 PMCID: PMC6546000 DOI: 10.15420/cfr.2018.40.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/12/2019] [Indexed: 01/03/2023] Open
Abstract
Climate change is a major contributor to annual winter peaks in cardiovascular events across the globe. However, given the paradoxical observation that cardiovascular seasonality is observed in relatively mild as well as cold climates, global warming may not be as positive for the syndrome of heart failure (HF) as some predict. In this article, we present our Model of Seasonal Flexibility to explain the spectrum of individual responses to climatic conditions. We have identified distinctive phenotypes of resilience and vulnerability to explain why winter peaks in HF occur. Moreover, we identify how better identification of climatic vulnerability and the use of multifaceted interventions focusing on modifiable bio-behavioural factors may improve HF outcomes.
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Affiliation(s)
- Simon Stewart
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town Cape Town, South Africa
| | - Trine T Moholdt
- Norwegian University of Science and Technology Trondheim, Norway
| | | | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town Cape Town, South Africa.,Australian Catholic University Melbourne, Australia
| | - Ana O Mocumbi
- Mozambique Institute for Health Education and Research Maputo, Mozambique
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142
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Seasonal variation in physical activity in patients with heart failure. Heart Lung 2019; 48:381-385. [PMID: 31122692 DOI: 10.1016/j.hrtlng.2019.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Physical activity is important for all heart failure (HF) patients to improve quality of life and physical function. Since adherence to physical activity is low and could differ between seasons, it is essential to explore factors related to change that may depend on seasonal changes. The purpose of this study was to describe the seasonal differences in physical activity and assess factors that influence these differences in a country with markedly different winter-to-summer weather conditions (in temperature, hours of daylight and snow fall). METHODS The study had a cross-sectional survey design. Outpatients with HF completed a questionnaire on physical activity, motivation and self-efficacy to exercise and HF symptom severity in the summer and the winter in a northern hemisphere country. We used analysis of variance to evaluate seasonal differences in physical activity, motivation, self-efficacy and HF symptom severity. RESULTS Eighty-seven patients with HF (29% women, mean age 70 ± 9 years) were included and 35% performed less physical activity (METs) in the winter, compared to the summer. Increased symptom severity during the winter was associated with lower activity levels. CONCLUSION One-third of the patients performed less physical activity during the winter compared to the summer, and this was associated with symptom severity. Decreased physical activity was not related with motivation and self-efficacy. This study emphasises the need for personalised physical activity programmes that also assess symptom severity and change in symptom severity depending between seasons.
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143
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Liang F, Yang X, Liu F, Li J, Xiao Q, Chen J, Liu X, Cao J, Shen C, Yu L, Lu F, Wu X, Zhao L, Wu X, Li Y, Hu D, Huang J, Liu Y, Lu X, Gu D. Long-term exposure to ambient fine particulate matter and incidence of diabetes in China: A cohort study. ENVIRONMENT INTERNATIONAL 2019; 126:568-575. [PMID: 30852444 DOI: 10.1016/j.envint.2019.02.069] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 05/09/2023]
Abstract
BACKGROUND Diabetes caused substantial economic and health burden worldwide. However, the associations between air pollution and diabetes incidence were rarely reported in the developing countries, especially in China with relatively high PM2.5 concentrations. OBJECTIVES A cohort-based study was conducted to assess the diabetes incidence associated with long-term exposure to ambient PM2.5. METHODS We collected individual health data and risk factors from the project of Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR Project) from 15 provinces over China. Diabetes was defined as fasting glucose levels ≥7.0 mmol/L at the follow-ups and/or the use of insulin or oral hypoglycemic agents and/or diagnosed medical history of diabetes during 2004 to 2015. Individual-level PM2.5 exposures were estimated from satellite-based PM2.5 concentrations (10 km spatial resolution) during the study period. Cox proportional hazards models with random intercepts of each cohort and region were employed to estimate the diabetes incidence attributable to PM2.5, after the adjustment for age, gender, body mass index, smoking status, education, work-related physical activity level, hypertension, urbanicity, county-level averaged years of education, and long-term levels of temperature and relative humidity. RESULTS A total of 88,397 subjects were analyzed with 580,928 person-years of follow-up after 2004, among which 6439 new cases of diabetes were observed. The mean age of the subjects was 51.7 years at baseline. For an increase of 10 μg/m3 in long-term PM2.5 exposure, the multivariable-adjusted percent increase in the diabetes incidence was estimated to be 15.66% (95% confidence interval: 6.42%, 25.70%). The adverse effects of PM2.5 were larger among females, rural subjects, non-smokers, normotensives, subjects younger than 65 years and subjects with body mass index <25 kg/m2. CONCLUSIONS Our findings provided evidence for the association of long-term exposure to PM2.5 with diabetes incidence in China. A sustained improvement of air quality will benefit the reduction for diabetes epidemic in China.
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Affiliation(s)
- Fengchao Liang
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xueli Yang
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Fangchao Liu
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jianxin Li
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Qingyang Xiao
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Jichun Chen
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xiaoqing Liu
- Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou 510080, China
| | - Jie Cao
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Chong Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Ling Yu
- Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou 350014, China
| | - Fanghong Lu
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan 250062, China
| | - Xianping Wu
- Sichuan Center for Disease Control and Prevention, Chengdu 610041, China
| | - Liancheng Zhao
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xigui Wu
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ying Li
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Dongsheng Hu
- Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen 518060, China
| | - Jianfeng Huang
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yang Liu
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Xiangfeng Lu
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
| | - Dongfeng Gu
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Vicent L, Bruña V, Devesa C, Sousa-Casasnovas I, Juárez M, Fernández-Avilés F, Martinez-Sellés M. Seasonality in Mortality in a Cardiology Department: A Five-Year Analysis in 500 Patients. Cardiology 2019; 142:67-72. [PMID: 30999316 DOI: 10.1159/000497815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 02/07/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous studies have indicated that cardiovascular mortality follows a seasonal trend. The aim of this work was to determine the evolution of mortality throughout the year in a cardiology department. METHODS All admissions and deaths occurring in our Cardiology Department over a 5-year period (2013-2017) were recorded retrospectively. RESULTS From a total of 17,829 hospital admissions, 500 patients died (2.8%, 0.3 patients/day). The mean age of deceased patients was 74.2 ± 13.1 years, and 186 (37.2%) were women. Mortality ranged from 0.17 deaths/day in August to 0.40 deaths/day in February (p = 0.03), and from 0.20 deaths/day in summer to 0.36 deaths/day in winter (p = 0.001). There was also a trend towards a variation in hospitalizations, with a peak in January (10.5 admissions/day) and the lowest figure in August (7.0 admissions/day), p = 0.047. We found no significant seasonal trend regarding mortality rate with respect to the number of hospital admissions (p = 0.89). The most common cause of death was refractory heart failure (267 patients [65.8%]). A noncardiac cause of death was observed in 134 patients (26.8%). CONCLUSIONS In a cardiology department, there are twice as many deaths in winter as in summer. Hospitalizations also tend to be more frequent in winter than in summer.
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Affiliation(s)
- Lourdes Vicent
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Vanesa Bruña
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Carolina Devesa
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Iago Sousa-Casasnovas
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Miriam Juárez
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Francisco Fernández-Avilés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Martinez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain, .,Universidad Complutense de Madrid, Madrid, Spain, .,Universidad Europea de Madrid, Madrid, Spain,
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145
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Metcalf CS, Huntsman M, Garcia G, Kochanski AK, Chikinda M, Watanabe E, Underwood T, Vanegas F, Smith MD, White HS, Bulaj G. Music-Enhanced Analgesia and Antiseizure Activities in Animal Models of Pain and Epilepsy: Toward Preclinical Studies Supporting Development of Digital Therapeutics and Their Combinations With Pharmaceutical Drugs. Front Neurol 2019; 10:277. [PMID: 30972009 PMCID: PMC6446215 DOI: 10.3389/fneur.2019.00277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/04/2019] [Indexed: 12/29/2022] Open
Abstract
Digital therapeutics (software as a medical device) and mobile health (mHealth) technologies offer a means to deliver behavioral, psychosocial, disease self-management and music-based interventions to improve therapy outcomes for chronic diseases, including pain and epilepsy. To explore new translational opportunities in developing digital therapeutics for neurological disorders, and their integration with pharmacotherapies, we examined analgesic and antiseizure effects of specific musical compositions in mouse models of pain and epilepsy. The music playlist was created based on the modular progression of Mozart compositions for which reduction of seizures and epileptiform discharges were previously reported in people with epilepsy. Our results indicated that music-treated mice exhibited significant analgesia and reduction of paw edema in the carrageenan model of inflammatory pain. Among analgesic drugs tested (ibuprofen, cannabidiol (CBD), levetiracetam, and the galanin analog NAX 5055), music intervention significantly decreased paw withdrawal latency difference in ibuprofen-treated mice and reduced paw edema in combination with CBD or NAX 5055. To the best of our knowledge, this is the first animal study on music-enhanced antinociceptive activity of analgesic drugs. In the plantar incision model of surgical pain, music-pretreated mice had significant reduction of mechanical allodynia. In the corneal kindling model of epilepsy, the cumulative seizure burden following kindling acquisition was lower in animals exposed to music. The music-treated group also exhibited significantly improved survival, warranting further research on music interventions for preventing Sudden Unexpected Death in Epilepsy (SUDEP). We propose a working model of how musical elements such as rhythm, sequences, phrases and punctuation found in K.448 and K.545 may exert responses via parasympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. Based on our findings, we discuss: (1) how enriched environment (EE) can serve as a preclinical surrogate for testing combinations of non-pharmacological modalities and drugs for the treatment of pain and other chronic diseases, and (2) a new paradigm for preclinical and clinical development of therapies leading to drug-device combination products for neurological disorders, depression and cancer. In summary, our present results encourage translational research on integrating non-pharmacological and pharmacological interventions for pain and epilepsy using digital therapeutics.
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Affiliation(s)
- Cameron S. Metcalf
- Department of Pharmacology and Toxicology, University of Utah, Salt Lake, UT, United States
| | - Merodean Huntsman
- Department of Medicinal Chemistry, University of Utah, Salt Lake, UT, United States
| | - Gerry Garcia
- Greatful Living Productions, Salt Lake, UT, United States
| | - Adam K. Kochanski
- Department of Atmospheric Sciences, University of Utah, Salt Lake, UT, United States
| | - Michael Chikinda
- The Gifted Music School, Salt Lake, UT, United States
- The School of Music, University of Utah, Salt Lake, UT, United States
| | | | - Tristan Underwood
- Department of Pharmacology and Toxicology, University of Utah, Salt Lake, UT, United States
| | - Fabiola Vanegas
- Department of Pharmacology and Toxicology, University of Utah, Salt Lake, UT, United States
| | - Misty D. Smith
- Department of Pharmacology and Toxicology, University of Utah, Salt Lake, UT, United States
- The School of Dentistry, University of Utah, Salt Lake, UT, United States
| | - H. Steve White
- School of Pharmacy, University of Washington, Seattle, WA, United States
| | - Grzegorz Bulaj
- Department of Medicinal Chemistry, University of Utah, Salt Lake, UT, United States
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146
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Loader J, Chan YK, Hawley JA, Moholdt T, McDonald CF, Jhund P, Petrie MC, McMurray JJ, Scuffham PA, Ramchand J, Burrell LM, Stewart S. Prevalence and profile of "seasonal frequent flyers" with chronic heart disease: Analysis of 1598 patients and 4588 patient-years follow-up. Int J Cardiol 2019; 279:126-132. [PMID: 30638747 DOI: 10.1016/j.ijcard.2018.12.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/16/2018] [Accepted: 12/21/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Peaks and troughs in cardiovascular events correlated with seasonal change is well established from an epidemiological perspective but not a clinical one. METHODS Retrospective analysis of the recruitment, baseline characteristics and outcomes during minimum 12-month exposure to all four seasons in 1598 disease-management trial patients hospitalised with chronic heart disease. Seasonality was prospectively defined as ≥4 hospitalisations (all-cause) AND >45% of related bed-days occurring in any one season during median 988 (IQR 653, 1394) days follow-up. RESULTS Patients (39% female) were aged 70 ± 12 years and had a combination of coronary artery disease (58%), heart failure (54%), atrial fibrillation (50%) and multimorbidity. Overall, 29.9% of patients displayed a pattern of seasonality. Independent correlates of seasonality were female gender (adjusted OR 1.27, 95% CI 1.01-1.61; p = 0.042), mild cognitive impairment (adjusted OR 1.51, 95% CI 1.16-1.97; p = 0.002), greater multimorbidity (OR 1.20, 95% CI 1.15-1.26 per Charlson Comorbidity Index Score; p < 0.001), higher systolic (OR 1.01, 95%CI 1.00-1.01 per 1 mmHg; p = 0.002) and lower diastolic (OR 0.99, 95% CI 0.98-1.00 per 1 mmHg; p = 0.002) blood pressure. These patients were more than two-fold more likely to die (adjusted HR 2.16, 95% CI 1.60-2.90; p < 0.001) with the highest and lowest number of deaths occurring during spring (31.7%) and summer (19.9%), respectively. CONCLUSIONS Despite high quality care and regardless of their diagnosis, we identified a significant proportion of "seasonal frequent flyers" with concurrent poor survival in this real-world cohort of patients with chronic heart disease.
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Affiliation(s)
- Jordan Loader
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Yih-Kai Chan
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - John A Hawley
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Christine F McDonald
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
| | - Pardeep Jhund
- British Heart Foundation Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Mark C Petrie
- British Heart Foundation Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - John J McMurray
- British Heart Foundation Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Paul A Scuffham
- School of Medicine, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
| | - Jay Ramchand
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia; Department of Cardiology, Austin Health, Melbourne, Australia
| | - Louise M Burrell
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia; Department of Cardiology, Austin Health, Melbourne, Australia
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147
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El Sibai R, Bachir R, El Sayed M. ECMO use and mortality in adult patients with cardiogenic shock: a retrospective observational study in U.S. hospitals. BMC Emerg Med 2018; 18:20. [PMID: 29973150 PMCID: PMC6031192 DOI: 10.1186/s12873-018-0171-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 06/21/2018] [Indexed: 12/21/2022] Open
Abstract
Background Extracorporeal membrane oxygenation (ECMO) is increasingly used in resuscitation of critically ill patients with documented improved survival. Few studies describe ECMO use in cardiogenic shock. This study examines ECMO use and identifies variables associated with mortality in patients treated for cardiogenic shock in US hospitals. Methods A retrospective observational study of the US Nationwide Emergency Department Sample (NEDS) database of 2013 was conducted. Weighted visits for cardiogenic shock (discharge diagnosis) with ECMO use were included. Collected data was analyzed and variables associated with mortality were identified. Results A total of 922 weighted patients with cardiogenic shock and ECMO were included. Mean age was 50.8 years. They were more commonly males (66.3%; n = 658). Slightly over half (51.0%, n = 506) survived to hospital discharge. Mean charges per patient were $589,610.5. Mean length of stay was 21.8 days. Increased mortality was associated with presence of respiratory diseases (OR = 3.83), genitourinary diseases (OR = 4.97), undergoing an echocardiogram (OR = 4.63), and presenting during seasons other than Fall. Lower mortality was noted in patients with injury and poisoning (OR = 0.47), in those who underwent certain vascular procedures (OR = 0.49) and those with increasing length of stay (OR = 0.90). Conclusion Mortality in patients with cardiogenic shock remains high despite ECMO use. Season of admission (other than Fall) and presence of specific comorbidities (Respiratory and genitourinary diseases) are associated with increased mortality in this population. Familiarity with these variables can help identify patients at higher risk of death and can help improve outcomes further in cardiogenic shock. Electronic supplementary material The online version of this article (10.1186/s12873-018-0171-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rayan El Sibai
- Department of Emergency Medicine, American University of Beirut Medical Center, P.O. Box - 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Rana Bachir
- Department of Emergency Medicine, American University of Beirut Medical Center, P.O. Box - 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Mazen El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center, P.O. Box - 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon. .,Emergency Medical Services and Prehospital Care Program, American University of Beirut Medical Center, Beirut, Lebanon.
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148
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Ohashi Y, Katsuta T, Tani H, Okabayashi T, Miyahara S, Miyashita R. Human cold stress of strong local-wind "Hijikawa-arashi" in Japan, based on the UTCI index and thermo-physiological responses. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:1241-1250. [PMID: 29602964 DOI: 10.1007/s00484-018-1529-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 02/13/2018] [Accepted: 03/14/2018] [Indexed: 06/08/2023]
Abstract
We investigated the cold stress caused by a strong local wind called "Hijikawa-arashi," through in situ vital measurements and the Universal Thermal Climate Index (UTCI). This wind is a very interesting winter phenomenon, localized in an area within 1 km of the seashore in Ozu City, Ehime Prefecture in Japan. When a strong Hijikawa-arashi (HA) occurred at 14-15 m s-1, the UTCI decreased to - 30 °C along the bridge where commuting residents are the most exposed to strong and cold winds. On the bridge, most participants in our experiment felt "very cold" or "extremely cold." The UTCI of HA can be predicted from a multiple regression equation using wind speed and air temperature. The cold HA wind is also harmful to human thermo-physiological responses. It leads to higher blood pressure and increased heart rate, both of which act as cardiovascular stress triggers. Increases of 6-10 mmHg and 3-6 bpm for every 10 °C reduction in UTCI were seen on all observational days, including HA and non-HA days. In fact, the participants' body skin temperatures decreased by approximately 1.2 to 1.7 °C for every 10 °C reduction in UTCI. Thus, the UTCI variation due to the HA outbreak corresponded well with the cold sensation and thermo-physiological responses in humans. This result suggests that daily UTCI monitoring enables the prediction of thermo-physiological responses to the HA cold stress.
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Affiliation(s)
- Yukitaka Ohashi
- Faculty of Biosphere-Geosphere Science, Okayama University of Science, 1-1 Ridai-cho, Kita-ku, Okayama City, Okayama, 700-0005, Japan.
| | - Takumi Katsuta
- Faculty of Biosphere-Geosphere Science, Okayama University of Science, 1-1 Ridai-cho, Kita-ku, Okayama City, Okayama, 700-0005, Japan
| | - Haruka Tani
- Faculty of Biosphere-Geosphere Science, Okayama University of Science, 1-1 Ridai-cho, Kita-ku, Okayama City, Okayama, 700-0005, Japan
| | - Taiki Okabayashi
- Faculty of Biosphere-Geosphere Science, Okayama University of Science, 1-1 Ridai-cho, Kita-ku, Okayama City, Okayama, 700-0005, Japan
| | - Satoshi Miyahara
- Institute of Environmental Informatics, IDEA Consultants, Inc., 2-2-2 Hayabuchi, Tsuzuki-ku, Yokohama City, Kanagawa, 224-0025, Japan
| | - Ryoji Miyashita
- Institute of Environmental Informatics, IDEA Consultants, Inc., 2-2-2 Hayabuchi, Tsuzuki-ku, Yokohama City, Kanagawa, 224-0025, Japan
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149
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Cannistraci CV, Nieminen T, Nishi M, Khachigian LM, Viikilä J, Laine M, Cianflone D, Maseri A, Yeo KK, Bhindi R, Ammirati E. "Summer Shift": A Potential Effect of Sunshine on the Time Onset of ST-Elevation Acute Myocardial Infarction. J Am Heart Assoc 2018; 7:JAHA.117.006878. [PMID: 29626152 PMCID: PMC6015398 DOI: 10.1161/jaha.117.006878] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background ST‐elevation acute myocardial infarction (STEMI) represents one of the leading causes of death. The time of STEMI onset has a circadian rhythm with a peak during diurnal hours, and the occurrence of STEMI follows a seasonal pattern with a salient peak of cases in the winter months and a marked reduction of cases in the summer months. Scholars investigated the reason behind the winter peak, suggesting that environmental and climatic factors concur in STEMI pathogenesis, but no studies have investigated whether the circadian rhythm is modified with the seasonal pattern, in particular during the summer reduction in STEMI occurrence. Methods and Results Here, we provide a multiethnic and multination epidemiological study (from both hemispheres at different latitudes, n=2270 cases) that investigates whether the circadian variation of STEMI onset is altered in the summer season. The main finding is that the difference between numbers of diurnal (6:00 to 18:00) and nocturnal (18:00 to 6:00) STEMI is markedly decreased in the summer season, and this is a prodrome of a complex mechanism according to which the circadian rhythm of STEMI time onset seems season dependent. Conclusions The “summer shift” of STEMI to the nocturnal interval is consistent across different populations, and the sunshine duration (a measure related to cloudiness and solar irradiance) underpins this season‐dependent circadian perturbation. Vitamin D, which in our results seems correlated with this summer shift, is also primarily regulated by the sunshine duration, and future studies should investigate their joint role in the mechanisms of STEMI etiogenesis.
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Affiliation(s)
- Carlo Vittorio Cannistraci
- Biomedical Cybernetics Group, Biotechnology Center (BIOTEC), Center for Molecular and Cellular Bioengineering (CMCB), Center for Systems Biology Dresden (CSBD), Department of Physics, Technische Universität Dresden, Dresden, Germany .,Brain Bio-Inspired Computing (BBC) Lab, IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Tuomo Nieminen
- Internal Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,South Karelia Central Hospital, Lappeenranta, Finland
| | - Masahiro Nishi
- Department of Cardiology, Omihachiman Community Medical Center, Omihachiman, Japan
| | - Levon M Khachigian
- Vascular Biology and Translational Research, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Juho Viikilä
- Cardiology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Mika Laine
- Cardiology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | | | | | | | | | - Enrico Ammirati
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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150
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Yin W, Hou J, Xu T, Cheng J, Li P, Wang L, Zhang Y, Wang X, Hu C, Huang C, Yu Z, Yuan J. Obesity mediated the association of exposure to polycyclic aromatic hydrocarbon with risk of cardiovascular events. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 616-617:841-854. [PMID: 29122344 DOI: 10.1016/j.scitotenv.2017.10.238] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 10/04/2017] [Accepted: 10/22/2017] [Indexed: 05/21/2023]
Abstract
Exposure to polycyclic aromatic hydrocarbons (PAHs) could cause high blood pressure (BP) and increased risk for atherosclerotic cardiovascular disease (ASCVD). However, the mechanisms underlying the relationship between them were unclear. We investigated potential mediation effect of obesity on the association of exposure to PAHs with high BP and increased risk for ASCVD. In the repeated measures study, 106 community-dwelling residents in Wuhan, China finished the physical examination in the winter and summer seasons, eight urinary PAHs metabolites were measured. Associations of urinary PAHs with high BP and increased risk for ASCVD were assessed using either linear mixed effect models or generalized estimating equations models. Mediation analysis was performed to evaluate the mediating effect of obesity on the association of urinary PAHs metabolites with high BP or increased risk of ASCVD. We observed the positive association between urinary PAHs metabolites and BP or the odds ratios for high BP (all P<0.05). Additionally, each one-unit increase in ln-transformed urinary levels of 4-hydroxyphenanthrene or the total of PAH metabolites was associated with a 12.63% or 11.91% increase in the estimated 10-year ASCVD risk (both P<0.05). The waist-to-height ratio mediated 29.0% of the association of urinary 4-hydroxyphenanthrene with increased risk of ASCVD (P<0.05). The findings suggest that PAHs exposure may be associated with elevated BP and an increased risk of ASCVD. Obesity may partially mediate the association between PAHs exposure and higher BP or increased risk of ASCVD.
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Affiliation(s)
- Wenjun Yin
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, PR China
| | - Jian Hou
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, PR China
| | - Tian Xu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, PR China
| | - Juan Cheng
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, PR China
| | - Pei Li
- State Key Laboratory of Organic Geochemistry, Guangdong Key Laboratory of Environment and Resources, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Guangzhou 510640, China
| | - Lin Wang
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, PR China
| | - Youjian Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, PR China
| | - Xian Wang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, PR China
| | - Chen Hu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, PR China
| | - Cheng Huang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, PR China
| | - Zhiqiang Yu
- State Key Laboratory of Organic Geochemistry, Guangdong Key Laboratory of Environment and Resources, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Guangzhou 510640, China.
| | - Jing Yuan
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, PR China.
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